RESUMO
Previous studies have shown that the interleukin-2-induced propagation of lymphocytes from endomyocardial biopsy specimens, an indicator of cellular rejection, is associated with the development of graft coronary disease in heart transplant patients. To further investigate the concept of cell-mediated immune responses in graft coronary disease, we have applied the methodologies of interleukin-2-induced propagation of lymphocytes from arterial tissues. In a group of 23 patients, which included 6 heart, 6 kidney, and 11 liver transplant recipients, we observed that arterial lymphocyte growth was significantly associated with obliterative vasculopathy (p less than 0.03). T-cell phenotyping analysis of coronary artery-derived lymphocyte cultures from three heart transplant patients with graft coronary disease showed significant numbers of CD4, CD8 double-negative T cells and T-cell receptor-gamma delta cells, especially when the cultures were established with relatively high doses of 400 U/ml of interleukin-2. These data suggest that the subset of CD4-CD8-, T cell receptor-gamma delta+ T cells may play a role in the pathogenesis and progression of graft coronary disease.
Assuntos
Relação CD4-CD8 , Doença das Coronárias/imunologia , Transplante de Coração , Complicações Pós-Operatórias/imunologia , Receptores de Antígenos de Linfócitos T gama-delta/imunologia , Linfócitos T/imunologia , Células Cultivadas , Doença das Coronárias/patologia , HumanosRESUMO
Cardiac events from graft arteriopathy, including myocardial infarction, heart failure resulting from previous myocardial infarction, and sudden death, may limit long-term survival after heart transplantation. To determine the incidence of cardiac events and the use of coronary arteriography in predicting these events, the long-term results (mean follow-up, 3.5 years; standard deviation +/- 2.0) of heart transplantation in 427 patients were reviewed. Cardiac events included 19 cases of myocardial infarction, 13 cases of sudden death, and 10 cases of congestive heart failure. All these events occurred after the first year except for three cases of sudden death and one case of myocardial infarction. Cumulative incidence of cardiac events per patient year was 0.9% within the first year, increasing to 1.9% by 5 years. Cardiac events accounted for 3.8% of the deaths by the end of the first year, rising to 18% of total mortality by 7 years after heart transplantation. In patients dying after the first year of transplantation, deaths from sequelae of coronary artery disease occurred in 36% (20/55). The relative risk ("odds ratio") of any cardiac event was 3.44 (p less than 0.05) in patients with angiographic evidence of obstructive disease compared with those without evidence of disease, risk of cardiac death 4.6 (p less than 0.05) and risk of sudden death, 2.4 (not significant). Of the 13 patients who died suddenly, five seen at autopsy were found to have had a recent myocardial infarction. Of all patients who died of heart disease, recent myocardial infarction was detected in nine who were seen at autopsy.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Doença das Coronárias/mortalidade , Transplante de Coração , Complicações Pós-Operatórias/mortalidade , Adolescente , Adulto , Idoso , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/etiologia , Seguimentos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Valor Preditivo dos Testes , Taxa de SobrevidaRESUMO
Review of 463 heart transplants was undertaken to examine the relationship between level of panel-reactive antibody (PRA) and a standard donor-specific lymphocytotoxic crossmatch (LXM) on the incidence of death from hyperacute, acute, and chronic rejection. Death from chronic rejection was defined as being caused by graft atherosclerosis. Hyperacute rejection was diagnosed in 18 allografts, and only two recipients had PRA greater than 10% and another two a positive LXM. Five-year actuarial freedom from death caused by all forms of rejection correlated with PRA values as follows: PRA 0% to 10% (415 patients), 85%; PRA 11% to 25% (29 patients), 68%; PRA greater than 25% (19 patients), 57% (p less than 0.005). Additionally, there was a positive linear relationship between PRA and duration of acute rejection episodes in the first 3 months after transplantation. A positive retrospective donor-specific LXM was present in 42 of 401 patients; most of them (32 patients) were low positive (10% to 50% cell death), and none could be correlated with antibody specificity toward donor HLA antigens. Five-year actuarial freedom from death caused by rejection was 83% in those with a negative LXM, 74% in those with low-positive, and 79% in those with high-positive LXM (p = NS). Negative LXM result did not reduce the risk of death caused by rejection in any of the PRA subgroups. While PRA greater than 10% is a risk factor for rejection-related events, a negative LXM in patients with an elevated PRA does not reduce the risk of death resulting from acute or chronic rejection.
Assuntos
Rejeição de Enxerto , Transplante de Coração/mortalidade , Análise Atuarial , Adulto , Especificidade de Anticorpos/imunologia , Testes Imunológicos de Citotoxicidade , Feminino , Seguimentos , Antígenos HLA/imunologia , Transplante de Coração/imunologia , Teste de Histocompatibilidade , Humanos , Incidência , Masculino , Fatores de Risco , Fatores de TempoRESUMO
Endomyocardial biopsy (EMB) of the right ventricle has demonstrated clinical use primarily for the detection of allograft rejection. Since its introduction, the procedure has been demonstrated to be safe and adaptable to an ambulatory population. The detection and grading of rejection have relied heavily on the criteria originally proposed by the Stanford group. Similar criteria are under study for diagnosis of myocarditis. Using autopsy-acquired cardiac allograft specimens, we report the reliability of EMB for grading of rejection and establish the dependence on the morphologic features used as the diagnostic cut-off and the fragment number obtained at biopsy. The reliability of an interpretation protocol based on the pattern of inflammation present in the multiple fragments submitted is established. We compare the reliability for rejection prediction between this approach and the currently accepted approach based on the presence of myocyte necrosis.