Humoral rejection after heart transplantation: reliability of intramyocardial electrogram recordings (IMEG) and myocardial biopsy

Transpl Int. 1997;10(6):439-45. doi: 10.1007/s001470050083.

Abstract

In recent years, as the importance of humoral-mediated rejection has increasingly become recognized, the fact that endomyocardial biopsies (BX) evaluated according to the criteria of the International Society for Heart and Lung Transplantation often produce false-negative results has become a matter of concern. To evaluate the reliability of measuring intramyocardial ECG amplitude (IMEG) and immunofluorescence evaluation (FITC-labeled anti-IgG/ IgM staining) of endomyocardial biopsies (IFM), heterotopic neck-heart transplantation (HTX) was performed on eight beagles previously sensitized through skin transplantations. After HTX, IMEG, echo, and donor-specific antibodies in serum (IgG, IgM) were determined daily and myocardial biopsies (IFM, BX) were performed once every 2 days. Accelerated (humoral) rejection occurred on the 5th (4th-5th) postoperative day and sensitivity of IMEG, IFM, and BX was 100%, 75%, and 12.5%, respectively. In each case rejection was recognized so early that it was possible to initiate therapy with "restitutio ad integrum". Our results show that, as opposed to endomyocardial biopsy (IFM, BX), IMEG diagnosis detected humoral-mediated rejection early and with high reliability.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anti-Inflammatory Agents / therapeutic use
  • Antibodies / blood
  • Antibodies / drug effects
  • Antibody Formation
  • Biopsy / standards
  • Blood Component Removal
  • Cortisone / therapeutic use
  • Cyclophosphamide / therapeutic use
  • Desensitization, Immunologic
  • Diastole / drug effects
  • Dogs
  • Edema / etiology
  • Edema / therapy
  • Electrocardiography / methods
  • Electrocardiography / standards
  • Graft Rejection / immunology
  • Graft Rejection / physiopathology*
  • Heart Transplantation / adverse effects
  • Heart Transplantation / immunology*
  • Heart Transplantation / pathology*
  • Heart Ventricles / drug effects
  • Heart Ventricles / pathology
  • Immunosuppressive Agents / therapeutic use
  • Lymphocytes / drug effects
  • Lymphocytes / pathology
  • Myocardium / pathology*
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Skin Transplantation / immunology
  • Time Factors

Substances

  • Anti-Inflammatory Agents
  • Antibodies
  • Immunosuppressive Agents
  • Cyclophosphamide
  • Cortisone