T-CELL AND MONOCYTE SUBSETS, INFLAMMATORY MOLECULES, REJECTION, AND HEMODYNAMICS EARLY AFTER CARDIAC TRANSPLANTATION

Background In the early period after cardiac transplantation, differen tial diagnosis of graft failure due to rejection, infection, and other causes is important but difficult. Methods. In 22 consecutive patient s undergoing heart transplantation, we prospectively determined levels of interleukin-6 as well as T-cell and monocyte subsets at eight poin ts in time during biopsy and right heart catheterization and within 12 hr of echocardiography during the first 3 months after transplantatio n. Results. Worse hemodynamic parameters, as characterized by dichotom ization according to median values (pulmonary capillary wedge pressure >10 mmHg, mean pulmonary arterial pressure >18 mmHg, pulmonary vascul ar resistance >115 dyn x sec x cm(-5), right atrial pressure >5 mmHg, cardiac index <3 L/min/m(2), early mitral deceleration time < 135 msec , and isovolumic relaxation time <80 msec), were associated with highe r levels of interleukin-6, C-reactive protein, polymorphonuclear cells , CD71(+)/CD14(+) monocytes, and IgM levels and, in contrast, with low er levels of immunocompetence markers such as CD3(+) T cells, CD4(+) T cells, CD8(+) T cells, CD3(+)/CD25(+) T cells, CD4(+)/ CD45RO(+) T ce lls, NK cells, and lower biopsy scores. Conclusion. Early after cardia c transplantation, elevated levels of inflammatory cells and soluble i nflammatory molecules and lower levels of immunocompetence markers are associated with impaired allograft function in the absence! of cellul ar rejection.