Adhesion molecule behavior during rejection and infection episodes after heart transplantation

In cardiac transplant recipients the release of soluble cellular adhesion m olecules intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-Selectin into serum is pronounced during immune activation. It is uncertain whether there is a specific pattern of release during infection or cardiac allograft rejection. In a prospective study, 30 consecutive cardiac allograft recipients were followed for a median period of 11.4 months (range 1-34). Soluble ICAM-1 (sICAM-1), soluble VCAM-1 (sVC AM-1) and soluble E-Selectin (sE-Selectin) were measured in addition to acu te phase proteins (C-reactive protein, cr,antitrypsin), complement factors (C3, C4) and beta(2)-microglobulin. The measured serum levels were correlat ed with the clinical status of the transplant recipient: 1) uneventful clin ical status; 2) asymptomatic infection; 3) symptomatic infection and 4) rej ection. Forty age-matched healthy subjects served as controls. Six days bef ore biopsy-proven cardiac allograft rejection sICAM-4-release started to in crease (p < 0.05) as compared to uneventful clinical status. The peak conce ntration of sICAM-1. was measured three days before rejection. On the day o f rejection, serum concentrations of sICAM-1 (p < 0.001) and sVCAM-1 (p < 0 .05) were increased, whereas sE-Selectin was not markedly elevated. In symp tomatic infections, the serum concentrations of sICAM-1 (p < 0.001) and sVC AM-1 (p <0.05) were elevated at the day of diagnosis and both parameters re ached peak levels three days after onset of chemotherapy. In multivariate a nalysis soluble adhesion molecules only weakly discriminated between reject ion and infection (sensitivity: 13%, specificity: 95%). Although, in combin ation with routine blood parameters the discriminatory power could be impro ved (sensitivity: 85%, specificity: 85%) the clinical utility of these mark ers in non-invasive monitoring is limited.