Researchers have identified a warning sign that could predict which heart transplant patients are at risk for developing coronary artery disease, the leading cause of transplant failure.
Patients who had two specific marker molecules, ICAM-1 and HLA-DR, in the endothelium of their coronary arteries within three months of a heart transplant were at greater risk of developing coronary artery disease. Of 121 patients who received heart transplants between 1988 and 1995, 20 (25.6%) of the 78 patients who were positive for the presence of the molecules and 3 (7%) of the 43 patients who tested negative rejected their heart transplants.
The findings were reported by Carlos A. Labarrere, MD, and his colleagues at Methodist Research Institute in Indianapolis in the October 8 issue of JAMA (1997;278:1169-1175).
"These findings show that early activation of arterial/arteriolar endothelium predicts the development of coronary artery disease, which is associated with a poor prognosis," they wrote. Early detection of transplant recipients at risk of rejection could help physicians modify treatment to prevent rejection, they said.
In an accompanying editorial (1997;278:1197-1198), H. Thomas Aretz, MD, and Robert B. Colvin, MD of Massachusetts General Hospital in Boston said that the findings provide "a potentially valuable measurement" for the evaluation of the development of coronary artery disease in heart transplant patients. Such a measurement technique would be particularly useful, they said, "since it could be performed on routine endomyocardial biopsy specimens obtained to monitor rejection and would therefore not require additional invasive techniques for risk assessment."
For Your Information:
Carlos A. Labarrere, MD
Center for Reproduction and Transplantation Immunology
Methodist Research Institute, Clarian Health
1701 N. Senate Boulevard, Indianapolis, IN 46202
Please be aware that medical advice, diagnoses and physician references cannot be obtained from this site.