Cardiogenic shock due to antibody-mediated rejection is associated with high short-term mortality after heart transplantation

Background Data are scarce about the prognosis of heart allograft antibody-mediated rejection (AMR) with hemodynamic involvement. Purpose To evaluate the prognosis of cardiogenic shock due to antibody mediated rejection. Methods We performed a retrospective, single center, observational study. We included all consecutive patients with (1) definite diagnosis of antibody-mediated (AMR) rejection treated at our center and (2) cardiogenic shock due to AMR. We analyzed survival after AMR and causes of death. Patients alive after AMR were followed to analyze recurrences of AMR, graft function and cardiac allograft vasculopathy. Results Finally, 17 patients met inclusion criteria. Four patients were transplanted with MFI > 1000 preformed DSA. Median time between heart transplantation and AMR was 21.5 months (10–64 months). AMR was mostly due to high-level class II de novo DSA (76% of patients). Despite aggressive immunosuppressive therapies, in-hospital and 1-year mortality were respectively as high as 76 and 82%. All patients discharged from hospital normalized LVEF during follow-up. However, 2 patients were diagnosed with recurrent subclinical AMR: one died suddenly at home and the other presented rapidly progressive cardiac allograft vasculopathy ( Fig. 1 ). Conclusion Despite aggressive immunosuppressive therapies, prognosis after cardiogenic shock due to AMR is poor with 76% in-hospital mortality. However, follow-up of patients discharged from hospital revealed normalization of LVEF.