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Predictors of Quilty Effect in a Population Bridged to Orthotropic Heart Transplantation with a Mechanical Circulatory Support Device

  • Author(s): Mehta, Seema Arun
  • Advisor(s): Schaenman, Joanna M
  • Elashoff, Robert M
  • et al.

Background: Quilty effect (QE), an infiltrate consisting of small vessels, B-cells, and T-cells is found exclusively in endomyocardial biopsies from heart transplant recipients. We hypothesize that mechanical circulatory support devices (MCSD) used as a bridge to transplantation (BTT) predispose orthotropic heart transplant (OHT) recipients to developing QE. We sought to 1) define the predictors of QE in those BTT with MCSD, and 2) determine the impact of QE on post-OHT outcomes.

Methods: A retrospective chart review was performed of all adult patients with MCSD, implanted for BTT, and successfully transplanted between 1996 and 2012 (N = 115). Using logistic regression, time-to-event curves, and Cox Proportional Hazards, clinical parameters were evaluated as predictors of the primary outcome, QE, and secondary outcomes of acute cellular rejection (ACR), pathologic antibody mediated rejection (pAMR), and death.

Results: 100 subjects developed QE (86.9%); 49 (43%) developed QE within the first 15 days post-OHT (early QE). Cyclosporine (CsA) use was protective of early QE (adjusted OR 0.29, p=0.02). Donor age decreased odds of ever developing QE (adjusted OR 0.94, p=0.03). QE increased one's odds of developing biopsy-proven ACR (adjusted OR 13.2, p=0.02). Cox Regression model revealed an adjusted HR of 0.61 (p=0.0007) for every 10-years of donor age.

Conclusions: QE incidence in this population was higher than prior studies have found. CsA use and donor age were associated with QE development, consistent with previously published reports. Studies comparing a BTT population with those who proceed directly to OHT, and assessing the recurrent nature of QE are necessary to better understand QE in this cohort.

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