title: Immune function surveillance: association with rejection, infection and cardiac allograft vasculopathy.
abstract: BACKGROUND
  Rejection, cardiac allograft vasculopathy (CAV), and infection are significant causes of mortality in heart transplantation recipients. Assessing the immune status of a particular patient remains challenging. Although endomyocardial biopsy (EMB) and angiography are effective for the identification of rejection and CAV, respectively, these are expensive, invasive, and may have numerous complications. The aim of this study was to evaluate the immune function and assess its utility in predicting rejection, CAV, and infection in heart transplantation recipients.
  
  
  METHODS
  We prospectively obtained samples at the time of routine EMB and when clinically indicated for measurement of the ImmuKnow assay (IM), 12 cytokines and soluble CD30 (sCD30). EMB specimens were evaluated for acute cellular rejection, and antibody-mediated rejection (AMR). CAV was diagnosed by the development of angiographic coronary artery disease. Infectious episodes occurring during the next 30 days after testing were identified by the presence of positive bacterial or fungal cultures and/or viremia that prompted treatment with antimicrobials.
  
  
  RESULTS
  We collected 162 samples from 56 cardiac transplant recipients. There were 31 infection episodes, 7 AMR, and 4 CAV cases. The average IM value was significantly lower during infection, (P = .04). Soluble CD30 concentrations showed significantly positive correlation with infection episodes, (P = .001). Significant positive correlation was observed between interleukin-5(IL-5) and AMR episodes (P = .008). Tumor necrosis factor-α and IL-8 showed significant positive correlation with CAV (P = .001).
  
  
  CONCLUSIONS
  Immune function monitoring appears promising in predicting rejection, CAV, and infection in cardiac transplantation recipients. This approach may help in more individualized immunosuppression and it may also minimize unnecessary EMBs and cardiac angiographies.
authors.affiliation: ARUP Institute for Clinical and Experimental Pathology, University of Utah school of Medicine, Salt Lake City, Utah 84132, USA. nahla.heikal@aruplab.com
authors.forename: N M
authors.initials: NM
authors.lastname: Heikal
authors.forename: F M
authors.initials: FM
authors.lastname: Bader
authors.forename: T B
authors.initials: TB
authors.lastname: Martins
authors.forename: I Y
authors.initials: IY
authors.lastname: Pavlov
authors.forename: A R
authors.initials: AR
authors.lastname: Wilson
authors.forename: M
authors.initials: M
authors.lastname: Barakat
authors.forename: J
authors.initials: J
authors.lastname: Stehlik
authors.forename: A G
authors.initials: AG
authors.lastname: Kfoury
authors.forename: E M
authors.initials: EM
authors.lastname: Gilbert
authors.forename: J C
authors.initials: JC
authors.lastname: Delgado
authors.forename: H R
authors.initials: HR
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D001706:Biopsy; D003324:Coronary Artery Disease / Q000628:therapy; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006321:Heart / Q000502:physiology; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007107:Immune System; D007165:Immunosuppression Therapy / Q000379:methods; D015848:Interleukin-5 / Q000378:metabolism; D017730:Ki-1 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011446:Prospective Studies; D012372:ROC Curve; D055815:Young Adult
chemical_list: D016207:Cytokines; D015848:Interleukin-5; D017730:Ki-1 Antigen