CARDIAC ALLOGRAFT VASCULOPATHY - ASSOCIATION WITH CELL-MEDIATED BUT NOT HUMORAL ALLOIMMUNITY TO DONOR-SPECIFIC VASCULAR ENDOTHELIUM
CARDIAC ALLOGRAFT VASCULOPATHY - ASSOCIATION WITH CELL-MEDIATED BUT NOT HUMORAL ALLOIMMUNITY TO DONOR-SPECIFIC VASCULAR ENDOTHELIUM
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DOI：
10.1161/01.cir.92.2.205
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发表时间：
1995-07-15
期刊：
影响因子：
37.8
通讯作者：
WAGNER, CR
中科院分区：
文献类型：
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作者：
HOSENPUD, JD;EVERETT, JP;WAGNER, CR
心脏移植物血管病变（CAV）是一种加速型冠状动脉疾病，是心脏移植术后晚期死亡的主要原因。虽然大多数人认为这种并发症的慢性同种异体移植排斥反应的表现，它还没有建立这种疾病是否是体液或细胞介导的allorectionality.Methods和结果的后果，人主动脉内皮细胞（HAECs）分离从供体aerodynastas在器官收购时获得的52个心脏同种异体移植受体。在移植后第一年的几个时间点，从这52例同种异体移植受者中获得血清和外周血单核细胞。淋巴细胞增殖（LP）响应于供体特异性HAECs和同种抗体结合干扰素-γ治疗的供体特异性HAECs进行，并与临床参数，包括HLA匹配，急性细胞排斥反应，冠状动脉疾病的监测血管造影。研究的52例患者中有10例在移植后第一年（CAV +组）有冠状动脉疾病的血管造影或尸检证据。移植后1周、3个月和6个月，CAV+组对供体HAECs的LP反应高于CAV-组（1周：1439+/-222 vs 824+/-141 cpm，P= 0.026; 3个月：1282+/-388 vs 884+/-94 cpm，P= 0.07; 6个月：2504+/-635 vs. 1540+/-209 cpm，P= 0.036;分别为CAV+ vs. CAV-）。52例患者中仅8例有供体特异性同种抗体，抗体的存在与CAV无关。与CAV相关的其他临床参数包括HLA-DR错配水平和晚期急性排斥反应的存在。结论CAV与供体特异性细胞介导的血管内皮同种异体反应性有关。体液免疫似乎在这种疾病中没有主要作用。
Background Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease responsible for the majority of late deaths after cardiac transplantation. Although most consider this complication a manifestation of chronic allograft rejection, it has not been established whether this disease is a consequence of humoral or cell-mediated alloreactivity.Methods and Results Human aortic endothelial cells (HAECs) were isolated from donor aortas obtained at the time of organ acquisition for 52 cardiac allograft recipients. Serum and peripheral blood mononuclear cells were obtained from these 52 allograft recipients at several time points during the first year after transplantation. Lymphocyte proliferation (LP) in response to donor-specific HAECs and alloantibody binding to interferon-gamma-treated donor-specific HAECs were performed and correlated with clinical parameters, including HLA matching, acute cellular rejection, and coronary artery disease on surveillance angiography. Ten of the 52 patients studied had angiographic or autopsy evidence of coronary artery disease in the first posttransplantation year (CAV + group). The CAV+ group had higher LP responses to their donor HAECs at 1 week, 3 months, and 6 months after transplantation compared with the CAV- group (1 week: 1439+/-222 versus 824+/-141 counts per minute [cpm], P=.026; 3 months: 1282+/-388 versus 884+/-94 cpm, P=.07; 6 months: 2504+/-635 versus 1540+/-209 cpm, P=.036; CAV+ versus CAV-, respectively). Only 8 of the 52 patients had donor-specific alloantibodies, and there was no relation between antibody presence and CAV. Other clinical parameters that correlated with CAV included the level of HLA-DR mismatch and the presence of late acute rejection.Conclusions CAV is associated with donor-specific cell-mediated alloreactivity to vascular endothelium. Humoral immunity does not appear to have a major role in this disease.