EVALUATION OF PLASMA CYCLIC-GMP ASSAY AS A SCREENING-TEST FOR DETECTION OF ACUTE CARDIAC ALLOGRAFT-REJECTION

Our aim was to assess the value of a single determination of plasma cy clic guanosine 3',5'-monophosphate (cGMP) in noninvasive screening for acute cardiac allograft rejection warranting augmentation of immunosu ppression. Plasma cGMP levels were measured in 26 patients I to 13 mon ths after heart transplantation on the same day the endomyocardial bio psies were performed. Acute moderate rejection (ISHLT 3A or 3B) was fo und in 10 out of 17 subjects (59%) with plasma cGMP >5 nmol/L, whereas there was mild or no rejection (ISHLT 0 to 1) in 8 from among 9 subje cts (89%) with cGMP <5 nmol/L. Because cGMP levels <5 nmol/L appear to argue against the presence of acute rejection requiring therapy modif ication, our preliminary results suggest that a single plasma cGMP ass ay might be helpful in establishing indications for endomyocardial bio psy in heart transplant recipients.