Elevated plasma tissue plasminogen activator and anti-THP-1 antibodies areindependently associated with decreased graft survival in cardiac transplant recipients

Hemostatic and immunologic factors have been implicated in future cardiac e vents in patients with coronary artery disease. The role of these factors a nd their interaction is less established in cardiac transplant recipients. We sought to characterize the role of these factors in these patients. Card iac transplant patients who presented for surveillance coronary angiography and/or endomyocardial biopsy were eligible for enrollment. Ninety-nine con secutive patients were enrolled. Plasma levels of tissue-type plasminogen a ctivator (t-PA), plasminogen activator inhibitor-1, von Willebrand factor, fibrin D-dimer, and anti-t-PA antibody were determined by enzyme-linked imm unosorbent assays. Anti-THP 1 cell antibodies directed against a monocytic leukemia cell line were detected by incubating patient plasma with THP-1 ce lls. Bound antibody was detected using goat peroxidase-labeled immunoglobul in C directed against human immunoglobulins. Lipids were measured by enzyma tic methods. Multivariate analysis identified the presence of anti-THP-1 ce ll antibodies (risk ratio 4.41, p = 0.002), t-PA antigen (risk ratio;1.10, p = 0.033), donor age 20 to 26 years (risk ratio 8.83, p = 0.042), and dono r age > 36 years (risk ratio 15.53, p = 0.009) as predictors of allograft f ailure. Altered hemostatic function, as demonstrated by elevated plasma t-P A antigen levels, is predictive of subsequent allograft failure in cardiac transplant recipients. In addition,the presence of anti-THP-1 cell antibodi es in these patients is predictive of allograft failure. (C) 2001 by Excerp ta Medico, Inc.