Immunologic Monitoring of the Cardiac Transplant Patient: Results

In: Cardiac Transplant

28 Mar 2015

Of 347 endomyocardial biopsies performed on 49 patients, 47 specimens demonstrated histologic evidence of acute rejection. In this study, acute rejection was characterized by the presence of interstitial edema with pyrinophilic lymphocytes, with or without myonecrosis. Simultaneous immune activation of peripheral blood lymphocytes occurred with 33 biopsy specimens positive for acute rejection (Table 1). Thus, the morphologic evaluation of lymphocytes demonstrated a 70 percent sensitivity in detecting an episode of acute cardiac rejection. The predictive value of a positive test (positive immune activation of lymphocytes) was 39 percent. Significant differences in absolute numbers of total lymphocytes, T-cell subsets (helper cells, cytotoxic-suppressor cells, cytotoxic cells, resetting T cells, mitogenic T cells) and helper/suppressor ratios analyzed via a Students t test revealed no consistent, statistically significant differences in absolute numbers of the above-described cell populations. During acute cardiac rejection, the helper/ suppressor ratio was variable, with high, low, and normal values noted. Here

Fifty-one episodes of lymphocyte activation were observed in the absence of acute cardiac rejection, demonstrating a specificity of 83 percent. The predictive value of a negative test (no immune activation of lymphocytes) was 94 percent (Table 2). Thirteen patients had lymphocyte activation at the time of documented infectious disease, including Escherichia coli sepsis, legionellosis, cavitary pulmonary aspergillosis, and viral illness. Five positive cytologic studies in three patients were associated with cytomegalovirus cystitis and herpes gastritis. Lymphocytes in these cases were large, with azurophilic, granular cytoplasm. All three patients demonstrated increased numbers of total lymphocytes and T cells, especially cytotoxic-suppressor cells; a decreased helper/suppressor ratio was noted in these cases.
Table 1—Numbers of Patients with Endomyocardial Biopsy Positive or Negative for Acute Rejection vs Presence or Absence cf Immune Activation of Lymphocytes

Endomyocardial Biopsy
+
33 51
Immune activation + (True positive) (False positive)
of peripheral blood 14 249
lymphocytes — (False negative) (True negative)

Table 2—Immune Activation of Peripheral Blood Lymphocytes (%)

Predictive Value Predictive Value
Sensitivity Specificity of Positive Test of Negative Test
70 83 39 94

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