The outcome of untreated mild rejection on endomyocardial biopsy may differ depending on specific immunosuppressive regimens. In addition, there is concern that ISHLT grade IB rejection does progress to a more severe form of rejection compared to ISHLT grade IA rejection. We reviewed 4,398 endomyocardial biopsies between January 1998 and December 2003 to assess the outcome of grade IA and IB rejections. There were 551 biopsies with grade IA rejection and 43 biopsies with grade IB rejections. These endomyocardial biopsies were divided into those on treatment with cyclosporine (CsA, n = 279) regimens and tacrolimus (Tac, n = 272) regimens. Between the two groups for 1A rejections, there were similar percentages of endomyocardial biopsies in both groups who cleared (CsA 91.0%, Tac 91.1%, p = .19), had persistent ISHLT grade rejection (CsA 7.1%, Tac 7.0%, p = .48), or progressed to a more severe form of rejection in follow-up endomyocardial biopsy (CsA 2.1%, Tac 2.0%, p = .28). For endomyocardial biopsies with 1B rejections, there were similar percentages of biopsies in both groups who cleared (CsA 97.7%, Tac 64.3%, p = .63), had persistent ISHLT grade rejection (CsA 0%, Tac 0%, p = 1.0), or progressed to a more severe form of rejection (CsA 2.3%, Tac 2.3%, p = .63). Endomyocardial biopsies were obtained while patients were treated with CsA and Tac, both in combination with azathioprine (n = 369) or mycophenolate mofetil (n = 112) or sirolimus (n = 100). There was no difference in outcomes for any specific immunosuppressive regimens for both grade 1A and 1B rejections.
Conclusion ISHLT grade 1A and 1B rejections are similar in outcomes and progress to a more severe rejection in a small minority of patients regardless of immunosuppression regimens. Therefore, continued nontreatment with follow-up biopsies only is warranted.
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