ANTI-SKELETAL MUSCLE GLYCOLIPID ANTIBODIES (AGA) AS PRETRANSPLANTATION RISK FACTOR FOR ACUTE HUMORAL AND CELLULAR REJECTION IN HEART TRANSPLANTATION

LAGUENS RP; VIGLIANO CA; ARGEL MI; CHAMBÓ JG; CABEZA MECKERT P; PERRONE SV; FAVALORO RR

Londres

Congreso; International Society for Heart and Lung Transplantation. Seventeenth annual meeting and scientific sessions.; 1997

International Society for Heart and Lung Transplantation

Recently we reported that the level of circulating AGA increased in coincidence with histologically diagnosed grades 2 and 3A rejection episodes (Transplantation 62:211-216, 1996). We report here that a high AGA level immediately before heart transplantation may represent a risk factor for a greater cumulative number of grade 3A and humoral rejection episodes during the first 120 days after transplant. In 45 patients blood samples were collected immediately before heart transplantation. Diagnosis of humoral or cellular rejection was carried out on 472 endomyocardial biopsies collected weekly during the first two months after transplant and biweekly thereafter. The AGA titer was determined by an ELISA assay as previously reported. The mean cumulative number of grade 3A rejection and humoral rejection episodes was 0.4 and 0.22 per patient respectively during the 4 months of the study. To determine whether the pretransplant AGA level was an independent predictive value for the development of grade 3A cellular or humoral rejection episodes as compared with other risk factors (age and sex of recipient, donor age and sex, blood group concordance, time of ischemia and positive or negative crossmatch) we carried out a multivariate analysis. Among all the risk factors considered the only significant for grade 3A cellular rejection was the AGA level at the moment of transplant (p=0.014) and for humoral rejection the only significant factors were a female donor (p=0.032) and the pretransplant AGA level (p=0.0099). These results indicate that determination of the circulating AGA level immediately before heart transplant may represent a useful predictor for the risk of developing humoral or cellular rejection episodes during the early post transplant period.