C-REACTIVE PROTEIN IN THE MONITORING OF ACUTE REJECTION AFTER HEART-TRANSPLANTATION

Histological examination of endomyocardial biopsy (EMB) is the main te chnique for rejection surveillance after heart transplantation. This t echnique is elaborate, inconvenient for the patient, and not without c omplications. We prospectively analyzed whether the measurement of C-r eactive protein (CRP), an acute phase protein that quickly rises when there is inflammation, can serve as a marker for immunological quiesce nce and as an indicator for withholding EMB. During a 6-month period, CRP was measured in all patients referred for EMB as part of the routi ne followup after heart transplantation. Acute rejection in patients w ith a follow-up of more than 1 year was rare (1/76). In the majority o f cases, EMB was taken within the 1-year post-transplantation (170/246 = 69%). In 71/170 biopsies (42 %), CRP was I 1; in the other 99/170 ( 58 %), CRP was greater than or equal to 2. When CRP was greater than o r equal to 1, acute rejection was diagnosed in 12/70 cases (17 %). In contrast, acute rejection was found in 28/99 cases (28 %) with CRP gre ater than or equal to 2 (P = 0.1). Although CRP is elevated more often in the presence of acute rejection, its sensitivity does not allow CR P to replace the routine performance of EMB for monitoring rejection a fter heart transplantation. We did, however, find a prognostic signifi cance with regard to the effect of rejection treatment: in all acute r ejections with a CRP greater than or equal to 3 (n = 11), steroids wer e effective.