An Evaluation of the Use of Hydralazine and the Risk of Heart Transplant Rejection

Abstract

Objectives: Assess the impact of hydralazine in contributing to the risk of heart transplant rejection. Our primary working hypothesis is that patients who have undergone heart transplantation and have taken hydralazine have an increased risk of transplant rejection and ultimately have worse outcomes. Methods: A retrospective cohort study on data extracted from a patient’s medical chart at a local hospital. Data was collected using a paper data extraction form consisting of gender, race, age, panel reactive antibody scores, co-morbidities, white blood cell count, type of immunosuppression therapy and any other medications. The proportion of patients with rejections will then be compared and analyzed using a chi square test. Results: This study obtained 340 patient cases that involved heart transplantation. From the 340 patients that were extracted, 42 of them were recorded as having taken hydralazine. Of the 42 patients, 7 had stopped hydralazine before transplantation. The mean +/- S.D. age of the 35 patients analyzed was 54 +/- 20.5 years, and 69% were men. Approximately 14% of the 42 patients were found to have had a heart transplant rejection. Conclusions: Heart transplant patients at this institution who received hydralazine post surgery were on it about an average of 21 months. Most patients were placed on ACE inhibitors. ACE inhibitors have a theoretical benefit of immunosuppression, and this therapy is usually pursued in transplant patients. Further research must be done to determine the clinical significance of hydralazine use in heart transplant rejection.