Donor-derived human leukocyte antigen class I proteins in the serum of heart transplant recipients.
BACKGROUND
Human leukocyte antigen class I proteins are expressed on most cell types in all organ allografts but are constitutively secreted only by certain organs, for example, the liver. We hypothesized that detectable levels of donor-derived human leukocyte antigen proteins would be released from transplanted cardiac allografts only when the allograft was immunologically stimulated, that is, during rejection and perhaps during viral infection. If so, then the release of donor human leukocyte antigen might be a noninvasive monitor of these events.


METHODS
We used an enzyme-linked immunosorbent assay to detect donor-derived human leukocyte antigen-A2 in the serum of 21 human leukocyte antigen-A2 negative recipients of human leukocyte antigen-A2-positive heart transplants. The level of donor human leukocyte antigen-A2 during the first 100 days after transplantation was correlated with the clinical status of the patient.


RESULTS
We found little or no donor human leukocyte antigen in the serum of heart transplant recipients whose postoperative clinical course was unremarkable for infection or rejection. We did find donor-derived human leukocyte antigen in the serum of heart transplant recipients transiently in the week immediately after transplantation, continuously from patients in whom chronic rejection was developing, during cytomegalovirus infection, and during some, but not all, acute rejection episodes as determined by endomyocardial biopsy.


CONCLUSIONS
These findings are consistent with the hypothesis that the donor human leukocyte antigen serum level reflects vascular diseases, rather than myocardial disease in the transplanted heart. Therefore, the serum level of donor human leukocyte antigen cannot be used as a monitor of cellular infiltration and myocyte damage as currently assessed by endomyocardial biopsy but may be an early indicator of the development of vascular disease such as chronic rejection.
Department of Surgery, University of Wisconsin-Madison, USA.
L D
LD
DeVito-Haynes
E
E
Jankowska-Gan
D
D
Heisey
N H
NH
Jutte
A H
AH
Balk
W
W
Weimar
F H
FH
Claas
T F
TF
Warner
R M
RM
Mentzer
R B
RB
Love
W J
WJ
Burlingham
D001706:Biopsy; D003586:Cytomegalovirus Infections / Q000097:blood / Q000276:immunology; D004699:Endocardium / Q000473:pathology; D004797:Enzyme-Linked Immunosorbent Assay; D006084:Graft Rejection / Q000097:blood / Q000276:immunology* / Q000473:pathology; D015789:HLA-A2 Antigen / Q000097:blood*; D015793:HLA-B7 Antigen / Q000097:blood; D016027:Heart Transplantation / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009206:Myocardium / Q000473:pathology; D012680:Sensitivity and Specificity; D014019:Tissue Donors
D015789:HLA-A2 Antigen; D015793:HLA-B7 Antigen; D007166:Immunosuppressive Agents