Cytoimmunologic monitoring as an adjunct in monitoring rejection after heart transplantation: results of a 6-year follow-up in heart transplant recipients.
The cytoimmunologic monitoring assay has been proposed as a useful noninvasive technique in the diagnosis of rejection and infection after heart transplantation. In this study, we have analyzed the diagnostic usefulness of cytoimmunologic monitoring in 73 patients after heart transplantation. For individual patients, the follow-up varied between 2 and 78 months. Data were related to histopathologic characteristics of the endomyocardial biopsy. Significantly different cytoimmunologic monitoring results were not observed between groups according to endomyocardial biopsy histopathologic evaluation. The diagnostic usefulness of cytoimmunologic monitoring depended on the cutoff value applied. With higher cutoff values, the sensitivity decreased and the specificity and predictive value increased. For the previously reported cutoff value of 5%, the sensitivity was 0.29, the specificity was 0.73, and the predictive value was 0.66. Values of sensitivity, specificity, and predictive value were similar when only the first acute rejection was taken into account, or when only data on the first 4 weeks and the first 6 months after transplantation were considered. In calculating the diagnostic usefulness of the sensitivity, specificity, and predictive values were observed. We concluded that cytoimmunologic monitoring has a limited value for diagnosing acute rejection after heart transplantation.
Wijngaard
P L
PL
Department of Immunology, Heart Transplantation Centre Utrecht/Groningen.
Doornewaard
H
H
van der Meulen
A
A
Plomp
S
S
Gmelig Meyling
F H
FH
de Jonge
N
N
Schuurman
H J
HJ
D000208:Acute Disease; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000627:therapeutic use; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D001706:Biopsy; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use; D004699:Endocardium / Q000473:pathology; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000517:prevention & control; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000276:immunology / Q000473:pathology; D006801:Humans; D007958:Leukocyte Count; D007963:Leukocytes, Mononuclear / Q000473:pathology; D018655:Lymphocyte Count; D016131:Lymphocyte Subsets / Q000473:pathology; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D015166:Monitoring, Immunologic; D011237:Predictive Value of Tests; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D013997:Time Factors
D000961:Antilymphocyte Serum; D016572:Cyclosporine; D001379:Azathioprine; D011241:Prednisone; D008775:Methylprednisolone