Very late heart transplant rejection is associated with microvascular injury, complement deposition and progression to cardiac allograft vasculopathy
There is ongoing debate as to the clinical importance of late rejection following heart transplantation detected on routine biopsy. More and more programs have moved away from routine biopsies beyond 3-5 years post-transplant, negating the possibility of even detecting this late rejection. In this provocative study, the authors assess both the pathologic charactistics, presence of donor-specific antibodies and outcomes in a cohort of patients beyond seven years post-transplant. Despite no difference between study groups, the changes identified in the late rejectors suggested an antibody-mediated process and were associated with progression to severe coronary artery vasculopathy in follow up.