TY - JOUR
T1 - Elevated soluble interleukin-2 receptor levels early after heart transplantation and long-term survival and development of coronary arteriopathy
AU - Young, J. B.
AU - Lloyd, K. S.
AU - Windsor, N. T.
AU - Cocanougher, B.
AU - Weilbaecher, D. G.
AU - Kleiman, Neal
AU - Smart, F. W.
AU - Nelson, D. L.
AU - Lawrence, E. C.
PY - 1991/1/1
Y1 - 1991/1/1
N2 - Rejection dynamics after heart transplantation might be characterized by soluble interleukin-2 receptor levels. To determine whether elevated levels early (measured by enzyme-linked immunosorbent assay once weekly the first 3 weeks at time of heart biopsy) after transplantation predict mortality and development of coronary disease, the means of these three determinations and the endomyocardial biopsy scores (McAllister scale 0-10) were compared for survivors and nonsurvivors and patients who had coronary arteriopathy develop and those who did not. Fifty-five patients alive 30 days after heart transplantation were prospectively followed up. Overall, 47 patients were male (85%), and the median age was 51 years. Mean ± SD follow-up was 26 ± 15 months (range, 1 to 54 months). There were 38 survivors (69%), and coronary arteriopathy developed in 15 patients (27%). Whereas mean ± SD heart biopsy scores for the early weeks were similar between survivors and nonsurvivors (3.6 ± 1.4 vs 4.4 ± 1.6; p > 0.05), the difference in soluble interleukin-2 receptor levels was significant(703 ± 362 U/ml vs 1793 ± 1070 U/ml; p <0.001). A mean level <1000 U/ml in any given patient predicted long-term survival with a 76% sensitivity, 79% specificity, and 88% negative predictive value. Mean receptor levels for those patients in whom coronary arteriopathy did not develop were 880 ± 846 U/ml and for those with this difficulty, 1410 ± 590 U/ml (p = 0.001). Late morbidity and mortality after heart transplantation seem predicted by early elevation of plasma soluble interleukin-2 receptor levels. More aggressive immunotherapy after heart transplantation might be warranted to attenuate some aspects of late mortality and morbidity if soluble interleukin-2 levels are noted to be consistently elevated early.
AB - Rejection dynamics after heart transplantation might be characterized by soluble interleukin-2 receptor levels. To determine whether elevated levels early (measured by enzyme-linked immunosorbent assay once weekly the first 3 weeks at time of heart biopsy) after transplantation predict mortality and development of coronary disease, the means of these three determinations and the endomyocardial biopsy scores (McAllister scale 0-10) were compared for survivors and nonsurvivors and patients who had coronary arteriopathy develop and those who did not. Fifty-five patients alive 30 days after heart transplantation were prospectively followed up. Overall, 47 patients were male (85%), and the median age was 51 years. Mean ± SD follow-up was 26 ± 15 months (range, 1 to 54 months). There were 38 survivors (69%), and coronary arteriopathy developed in 15 patients (27%). Whereas mean ± SD heart biopsy scores for the early weeks were similar between survivors and nonsurvivors (3.6 ± 1.4 vs 4.4 ± 1.6; p > 0.05), the difference in soluble interleukin-2 receptor levels was significant(703 ± 362 U/ml vs 1793 ± 1070 U/ml; p <0.001). A mean level <1000 U/ml in any given patient predicted long-term survival with a 76% sensitivity, 79% specificity, and 88% negative predictive value. Mean receptor levels for those patients in whom coronary arteriopathy did not develop were 880 ± 846 U/ml and for those with this difficulty, 1410 ± 590 U/ml (p = 0.001). Late morbidity and mortality after heart transplantation seem predicted by early elevation of plasma soluble interleukin-2 receptor levels. More aggressive immunotherapy after heart transplantation might be warranted to attenuate some aspects of late mortality and morbidity if soluble interleukin-2 levels are noted to be consistently elevated early.
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M3 - Article
C2 - 2031920
AN - SCOPUS:0025755510
SN - 1053-2498
VL - 10
SP - 243
EP - 250
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 2
ER -