title: Delayed xenograft rejection of pig-to-baboon cardiac transplants after cobra venom factor therapy.
abstract: BACKGROUND
  This study sought to (i) investigate the efficacy of cobra venom factor (CVF) in preventing hyperacute rejection (HAR) after pig-to-baboon heart transplantation, (ii) examine the effect of additional splenectomy (Spx) and pharmacologic immunosuppression (IS), and (iii) study delayed graft rejection when HAR is avoided by complement depletion.
  
  
  METHODS
  Eleven recipient baboons received heterotopic pig heart transplants. Three received either no therapy or IS (cyclosporine + methylprednisolone +/- cyclophosphamide +/- methotrexate) at clinically well-tolerated doses, with graft survival for only 40, 32, and 15 min, respectively. Two received CVF+/-Spx, which extended survival to 5 and 6 days, respectively. Six underwent Spx + CVF therapy + IS; graft survival was 3 hr (technical complication), 6 days (death from sepsis), 10, 12, and 22 days (vascular rejection), and <25 days (euthanized for viral pneumonia with a functioning graft that showed histopathologic features of vascular rejection).
  
  
  RESULTS
  Dense deposition of IgM and, to a lesser extent, IgG and IgA were seen on the endothelial cells within 1 hr of transplantation, but only trace levels of complement deposition were present in CVF-treated recipients. Within approximately 5-12 days, cardiac xenografts showed progressive infiltration by mononuclear cells, consisting primarily of activated macrophages producing tumor necrosis factor-alpha and small numbers of natural killer cells; T and B cells were absent.
  
  
  CONCLUSIONS
  We conclude that (i) CVF prevents HAR, (ii) the addition of Spx + IS delays rejection, but (iii) the early deposition of antibody leads to progressive graft injury, resulting in (iv) delayed vascular rejection. Our findings indicate that the features of delayed xenograft rejection described in small animal models also occur in the pig-to-baboon model, and that rejection may occur in a complement-independent manner from the effects of antibody and/or host macrophages.
authors.affiliation: Oklahoma Transplantation Institute, Baptist Medical Center, Oklahoma City, USA.
authors.forename: T
authors.initials: T
authors.lastname: Kobayashi
authors.forename: S
authors.initials: S
authors.lastname: Taniguchi
authors.forename: F A
authors.initials: FA
authors.lastname: Neethling
authors.forename: A G
authors.initials: AG
authors.lastname: Rose
authors.forename: W W
authors.initials: WW
authors.lastname: Hancock
authors.forename: Y
authors.initials: Y
authors.lastname: Ye
authors.forename: M
authors.initials: M
authors.lastname: Niekrasz
authors.forename: S
authors.initials: S
authors.lastname: Kosanke
authors.forename: L J
authors.initials: LJ
authors.lastname: Wright
authors.forename: D J
authors.initials: DJ
authors.lastname: White
authors.forename: D K
authors.initials: DK
authors.lastname: Cooper
mesh_terms: D000208:Acute Disease; D000818:Animals; D003520:Cyclophosphamide / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004546:Elapid Venoms / Q000627:therapeutic use*; D006084:Graft Rejection / Q000517:prevention & control*; D016027:Heart Transplantation / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008727:Methotrexate / Q000627:therapeutic use; D008775:Methylprednisolone / Q000627:therapeutic use; D009206:Myocardium / Q000166:cytology / Q000276:immunology; D010215:Papio; D013156:Splenectomy; D013552:Swine; D014183:Transplantation, Heterologous / Q000276:immunology*
chemical_list: D004546:Elapid Venoms; D007166:Immunosuppressive Agents; C016310:cobra venom factor; D016572:Cyclosporine; D003520:Cyclophosphamide; D008775:Methylprednisolone; D008727:Methotrexate