CYTOIMMUNOLOGIC MONITORING AS AN ADJUNCT IN MONITORING REJECTION AFTER HEART-TRANSPLANTATION - RESULTS OF A 6-YEAR FOLLOW-UP IN HEART-TRANSPLANT RECIPIENTS

The cytoimmunologic monitoring assay has been proposed as a useful non invasive technique in the diagnosis of rejection and infection after h eart transplantation. In this study, we have analyzed the diagnostic u sefulness of cytoimmunologic monitoring in 73 patients after heart tra nsplantation. For individual patients, the follow-up varied between 2 and 78 months. Data were related to histopathologic characteristics of the endomyocardial biopsy. Significantly different cytoimmunologic mo nitoring results were not observed between groups according to endomyo cardial biopsy histopathologic evaluation. The diagnostic usefulness o f cytoimmunologic monitoring depended on the cutoff value applied. Wit h higher cutoff values, the sensitivity decreased and the specificity and predictive value increased. For the previously reported cutoff val ue of 5%, the sensitivity was 0.29, the specificity was 0.73, and the predictive value was 0.66. Values of sensitivity, specificity, and pre dictive value were similar when only the first acute rejection was tak en into account, or when only data on the first 4 weeks and the first 6 months after transplantation were considered. In calculating the dia gnostic usefulness of cytoimmunologic monitoring for diagnosing only g rade 2 rejections, slightly higher values for the sensitivity, specifi city, and predictive values were observed. We concluded that cytoimmun ologic monitoring has a limited value for diagnosing acute rejection a fter heart transplantation.