ROUTINE INTRAOPERATIVE APPLICATION OF HIGH-DOSE APROTININ IN OPEN-HEART-SURGERY IN ADULTS - ANTIBODY-FORMATION AFTER FIRST EXPOSURE

High-dose aprotinin is now routinely used in cardiac surgery to reduce post-operative blood loss and transfusion requirements, although seve ral cases of anaphylactic reactions to the proteinase inhibitor have b een reported. As part of a multi-centre study to evaluate the immunolo gical response to aprotinin after first exposure 61 cardiac surgical p atients were treated with the Hammersmith regimen. Patients with previ ous aprotinin exposure were excluded from the study. To determine spec ific IgG and IgE antibodies blood samples were taken pre-operatively, within 3 to 4 weeks and 6 to 7 months after operation. Determinations were made by using Western Blot and ELISA methods. Fifty-six patients were followed up for a 6-month period, 26 (46.4%) of them developed Ig G antibodies to aprotinin determined by Western Blot, whereas only 14 (26.8%) patients with IgG antibodies were found by the ELISA. IgE anti bodies were not found in any of the patients. On hospital admission an d 6 months post-operatively additional intradermal prick tests were pe rformed. No clear-cut positive reaction to the skin test was found in any patient.