T-cell and monocyte subsets, inflammatory molecules, rejection, and hemodynamics early after cardiac transplantation

Background In the early period after cardiac transplantation, differential diagnosis of graft failure due to rejection, infection, and other causes is important but difficult. Methods. In 22 consecutive patients undergoing heart transplantation, we prospectively determined levels of interleukin-6 as well as T-cell and monocyte subsets at eight points in time during biopsy and right heart catheterization and within 12 hr of echocardiography during the first 3 months after transplantation. Results. Worse hemodynamic parameters, as characterized by dichotomization according to median values (pulmonary capillary wedge pressure >10 mmHg, mean pulmonary arterial pressure >18 mmHg, pulmonary vascular resistance >115 dyn x sec x cm(-5), right atrial pressure >5 mmHg, cardiac index <3 L/min/m(2), early mitral deceleration time < 135 msec, and isovolumic relaxation time <80 msec), were associated with higher levels of interleukin-6, C-reactive protein, polymorphonuclear cells, CD71(+)/CD14(+) monocytes, and IgM levels and, in contrast, with lower levels of immunocompetence markers such as CD3(+) T cells, CD4(+) T cells, CD8(+) T cells, CD3(+)/CD25(+) T cells, CD4(+)/ CD45RO(+) T cells, NK cells, and lower biopsy scores. Conclusion. Early after cardiac transplantation, elevated levels of inflammatory cells and soluble inflammatory molecules and lower levels of immunocompetence markers are associated with impaired allograft function in the absence! of cellular rejection.