Alterations in the fibrinolytic cascade post-transplant: evidence of a bimodal expression pattern.
BACKGROUND
Changes in the fibrinolytic system that occur after cardiac transplantation (CTx) and the factors that influence such changes have been poorly described, yet may be important in determining the varying morphologic features of transplant-related coronary artery disease (TxCAD).


METHODS
Baseline demographic as well as serial clinical information and plasma fibrinolytic levels were prospectively recorded pre-CTx and at multiple time-points post-CTx in 110 de novo cardiac transplant recipients.


RESULTS
We noted a biphasic change in fibrinolytic activity over the first year of CTx with an early immediate decline in plasminogen activator inhibitor-1 (PAI-1) activity (p > 0.001) matched with stable PAP (plasmin) activity corresponding to an "enhanced" fibrinolytic state early post-CTx. This was followed by a significant increase at 6 months (p = 0.004) and 1 year (p < 0.001) in PAI-1 activity concomitant with a significant decline in PAP after 3 months (p = 0.005 at 3 months, p < 0.001 at 6 months, p < 0.001 at 1 year) corresponding to an "impaired" fibrinolytic state late post-CTx.


CONCLUSIONS
The biphasic nature of the fibrinolytic system observed herein may account for the varying morphologic features of TxCAD.
Benza
Raymond L
RL
Department of Medicine, Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA. rbenza@uab.edu
Cavender
Matthew A
MA
Barchue
Joseph
J
Tallaj
Jose A
JA
Bourge
Robert C
RC
Kirklin
James K
JK
Coffey
Christopher S
CS
D000328:Adult; D000704:Analysis of Variance; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005342:Fibrinolysis; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism*; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment
D017395:Plasminogen Activator Inhibitor 1; D005340:Fibrinogen