Plasma protein changes in acute cardiac allograft rejection
Rejection is the major cause of morbidity and mortality during the first year following
transplantation. We have reported that 63% of our heart recipients had rejection within one
year and the mean number episodes in the first year after transplant was 1.14. Diagnosis and
treatment of acute rejection have evolved tremendously since the first human heart
transplantation in the 1960s. At present the detection of rejection relies mostly on the
pathological examination of endomyocardial biopsy specimens. The majority of cardiac
transplant centers have a fixed schedule for patients to undergo endomyocardial biopsy.
However, this approach is invasive and is associated with significant morbidity and mortality.
The easiest way for early detection of acute cellular rejection is to find the
rejection-associated molecules in the blood of the recipients.
These serum markers is supposed to be released into the cardiac veins and finally drained into
coronary sinus and right atrium. We report our preliminary results of several serum markers
in coronary sinus and peripheral blood in patients with heart transplantation.
From the standpoint of immune response in cardiac allograft rejection, the possible candidates
of rejection-associated molecules included:
1. Conventional markers: Troponin-I.
2. Acute phase proteins: C-reactive protein (CRP).
3. Cytokines: interleukin-2 (IL-2), tumor necrosis factors-alpha (TNF).
4. Adhesion molecules: ICAM-1, P-selectin.
There were 71 blood samples from 51 patients of cardiac post-transplantation. The
post-transplantation period ranged from one week to five years. For the samples from the
same subjects, the minimal sampling interval was 12 days and the maximal was two years.
Each sample was considered as independent, because within-subject samples were taken with
adequate intervals between them.
Same special markers between coronary sinus (CS) and peripheral blood (PB) were
significantly correlated. Among them, there were also significant correlations. P-selectin may
correlate with renal function. ICAM may correlate with liver function. CRP may correlate
with WBC. Lots of variables differed between early and late HTx groups and between
infection and non-infection groups. TNF-PB differed between CAD and non-CAD groups
(p=0.0498). IL2-PB differed between rejection and non-rejection groups (p=0.0409). CRP-PB
differed between long and short survivors (p=0.0273). Troponin-I-PB differed between statin
users and non-users (p=0.0177). CHO differed between Tapal users and non-users
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