ANTI-SKELETAL MUSCLE GLYCOLIPID ANTIBODIES IN HUMAN HEART-TRANSPLANTATION AS PREDICTORS OF ACUTE REJECTION - COMPARISON WITH OTHER RISK-FACTORS

In forty-five patients who underwent orthotopic heart transplantation, the titer of anti-human skeletal muscle glycolipid antibodies (ACA) p resent in the sera at the moment of transplantation was correlated wit h the number of histologically diagnosed cellular grade 3A and humoral acute rejection episodes during the first 120 days after transplantat ion. Determination of a cutoff value of 0.800 for the AGA level was de termined by a receiver operating characteristic curve. Thirteen of 19 patients (68.4%) with an AGA titer above 0.800 developed 24 severe rej ection episodes, and of the 26 patients with an AGA titer below 0.800, only 4 (15.3%) presented 6 severe rejection episodes during that time , This was especially evident for the humoral rejection episodes, whic h were diagnosed in only 1 of the 26 patients with AGA below 0.800 and in 7 of the 19 with AGA above 0.800. Comparison by univariate analysi s of other well-known risk factors for a greater number of rejection e pisodes during the early posttransplant period with the AGA level at t he moment of transplantation revealed that the latter distinguished a greater number of patients at risk than the other factors, such as a f emale donor, the lymphocyte direct cross-match, or the status of the p atients at transplantation; the odds ratios were 6.33 for the AGA leve l, 3.17 for the direct cross-match, and 2.76 for the status at transpl antation. By multiple logistic regression analysis, the only relevant risk factors in our group of patients were the AGA level (P=0.0009) an d the status at transplantation (P=0.0285). These results indicate tha t determination of the AGA level at the moment of transplantation coul d represent a useful method for distinguishing which patients are at r isk for a greater number of rejection episodes during the early posttr ansplant period, with a greater sensitivity than other risk factors.