Circulation, Vol 85, 61-68, Copyright © 1992 by American Heart Association
M Ballester, D Obrador, I Carrio, C Moya, JM Auge, R Bordes, V Marti, I Bosch, L Berna-Roqueta and M Estorch
BACKGROUND. Detection and treatment for rejection after transplantation are
based on the identification of myocyte damage upon endomyocardial biopsy.
Noninvasive detection of such damage is possible with 111In- labeled
monoclonal antimyosin antibodies (MAA). Although the presence and degree of
MAA uptake parallels the rejection activity detected by biopsy, the
relation between the degree of uptake and the occurrence of severe
rejection-related complications has not been previously assessed. METHODS
AND RESULTS. Two hundred forty-seven MAA studies were performed coinciding
with biopsies in 52 patients 1-71 months after transplantation. A
heart-to-lung ratio (HLR) was used as a measure of relative MAA uptake,
with an HLR of 1.55 discriminating normal from abnormal studies. Of the 247
antimyosin studies, 149 coincided with absent, 38 with mild, and 60 with
moderate rejection at biopsy. HLR was 1.68 +/- 0.27, 1.79 +/- 0.22, and
1.91 +/- 0.33 in the three biopsy groups, respectively (p less than
0.0001). Two hundred thirty-eight of 247 antimyosin studies coexisted with
absent rejection-related complications; in nine of 247 patients, such
complications were detected (five congestive heart failure episodes due to
rejection and four episodes of vascular occlusion, which resulted in five
deaths), and mean HLR was 1.74 +/- 0.3 and 2.1 +/- 0.16 in the two groups,
respectively (p less than 0.0001). No complications were noted in 193
studies of patients with HLR of less than 2.00, whereas in nine of 45 with
HRL of 2.00 or greater, complications occurred (p less than 0.0001). None
of the 23 patients prospectively followed since surgery who had a gradual
decrease in MAA uptake during the first 3 months showed rejection-related
complications, whereas persistent uptake was associated with complications
in five of nine patients (p less than 0.001). CONCLUSIONS. No
rejection-related complications are seen coinciding with HLR of less than
2.00, whereas patients who have complications have an HLR of more than
2.00. The early 3-month pattern of decreasing MAA uptake is associated with
a clinical course free of rejection-related complications, whereas a
persistent pattern is a signal of the possibility of such complications.
ARTICLES
Early postoperative reduction of monoclonal antimyosin antibody uptake is associated with absent rejection-related complications after heart transplantation
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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