The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 215-222, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Monitoring of mononuclear cell subsets isolated from the coronary sinus and the right atrium in patients after heart allograft transplantation
C Holzinger, A Zuckermann, A Laczkovics, R Seitelberger, G Laufer, S Andert, F Kink, R Horvart and E Wolner
Department of Surgery, University of Vienna, Austria.
The rejection of a transplanted heart leads to an accumulation of
mononuclear cells in the cardiac tissue and to reactions of the antigen-
recognizing cells with the foreign tissue. Consequently, during rejections
immunologic changes, such as the number of mononuclear cells and the
patterns of mononuclear cell subpopulations, should be detectable by
analysis of mononuclear cells from the coronary sinus of transplanted
hearts. Seventy-nine endomyocardial biopsies were performed in 37 patients.
Severity of graft rejection was classified by the Billingham scheme.
Thirty-two biopsy specimens showed no rejection, 33 mild, and 14 moderate
rejection. After endomyocardial biopsy the coronary sinus was catheterized
under x-ray guidance. Heparinized blood samples were obtained from the
coronary sinus and the right atrium, and mononuclear cell counts and
subpopulation pattern were compared. Patients without rejection and
patients with mild rejection showed no significant differences in the
patterns of mononuclear cell subpopulation identified in right atrium
blood. However, a significant (1.56-fold) increase of mononuclear cells was
assessed in the CS blood (p less than 0.01). Moderate rejections showed a
4.2-fold augmentation of mononuclear cells in the coronary sinus (p less
than 0.005) compared with nonrejections. In addition, the T-helper/inducer
(CD4) percentage increased from 27.1% in the right atrium to 41.2% in the
coronary sinus (p less than 0.005), natural killer cells (CD16) from 17.7%
to 31.8% (p less than 0.005), and the interleukin 2 receptor-bearing cells
from 6.6% to 15.3% (p less than 0.005). Percentage of pan-T cells (CD3), T-
cytotoxic/suppressor cells (CD8), and monocytes (CD14) showed no
statistically significant changes. These findings correlated with grading
according to endomyocardial biopsy. Using the ratio of values obtained from
cells of the coronary sinus and the right atrium rendered the coronary
sinus immunologic monitoring independent of changes in the administered
immunosuppressive regimen. The specificity of the described method was as
good as that of endomyocardial biopsy. It is concluded that the
discrimination of the patterns of mononuclear cell subpopulations from
right atrium versus coronary sinus blood samples is highly sensitive and
allows the correct diagnosis of graft rejection within 1 to 2 hours.
