Jutte N H, Groeneveld K, Balk A H, Ouwehand A J, Loonen E H, Van der Linden M, Strikwerda S, Mochtar B, Claas F H, Weimar W
Department of Internal Medicine I, Erasmus University/University Hospital Dijkzigt, Rotterdam, The Netherlands.
Clin Exp Immunol. 1994 Oct;98(1):158-62. doi: 10.1111/j.1365-2249.1994.tb06623.x.
Long-term survival of heart transplant recipients is limited by the development of transplant coronary artery disease (TCAD). We analysed whether the development of TCAD is correlated with the incidence of acute rejection episodes, with the formation of anti-HLA antibodies or with the composition and function of T lymphocyte cultures derived from endomyocardial biopsies. TCAD was assessed by visual analysis of annually performed coronary angiograms and defined as the presence of all vascular changes, including minor wall irregularities. One year after transplantation, 31 of the 77 patients studied had TCAD (40%). The median age and mean number of HLA mismatches in patients with or without TCAD were highly comparable. The patient groups did not differ in incidence of acute rejection episodes, nor in percentage of endomyocardial biopsies yielding T cell cultures. At 1 year after transplantation, lymphocyte cultures from 18/31 TCAD+ patients (58%) and 27/46 TCAD- patients (57%) were analysed. The TCAD+ patients had, compared with the TCAD- patients, a higher median percentage of CD8+ T cells (71% versus 25%, P = 0.06) and a lower median percentage of CD4+ T cells (4% versus 40%, P = 0.04). Similar differences were found in a longitudinal analysis of the culture results of endomyocardial biopsies (EMBs) obtained during the first year. The cytotoxic reactivity of the cultures against donor HLA class I or class II antigens was comparable in the two groups, although a difference in recognition of heart specific antigens remains possible. The fact that EMB-derived cultures from TCAD+ and TCAD- patients differed in T cell phenotype populations gives some support to the hypothesis that cellular immunological processes are involved in the development of TCAD. However, while the median values differed, the overlap of the percentages of CD8+ cells in cultures from TCAD- and TCAD+ patients shows that other factors besides CD8+ T cells also play a role.
心脏移植受者的长期存活受到移植冠状动脉疾病（TCAD）发展的限制。我们分析了TCAD的发展是否与急性排斥反应的发生率、抗HLA抗体的形成或来自心内膜活检的T淋巴细胞培养物的组成和功能相关。通过对每年进行的冠状动脉造影进行视觉分析来评估TCAD，并将其定义为所有血管变化的存在，包括轻微的管壁不规则。移植后一年，77例研究患者中有31例患有TCAD（40%）。有或没有TCAD的患者的年龄中位数和HLA错配平均数高度可比。两组患者在急性排斥反应的发生率以及产生T细胞培养物的心内膜活检百分比方面没有差异。移植后1年，分析了18/31例TCAD阳性患者（58%）和27/46例TCAD阴性患者（57%）的淋巴细胞培养物。与TCAD阴性患者相比，TCAD阳性患者的CD8 + T细胞中位数百分比更高（71%对25%，P = 0.06），CD4 + T细胞中位数百分比更低（4%对40%，P = 0.04）。在对第一年获得的心内膜活检（EMB）培养结果的纵向分析中也发现了类似的差异。两组培养物对供体HLA I类或II类抗原的细胞毒性反应相当，尽管对心脏特异性抗原的识别差异仍然可能存在。来自TCAD阳性和阴性患者的EMB衍生培养物在T细胞表型群体上存在差异这一事实为细胞免疫过程参与TCAD发展的假说提供了一些支持。然而，虽然中位数不同，但TCAD阴性和阳性患者培养物中CD8 + 细胞百分比的重叠表明，除了CD8 + T细胞之外，其他因素也起作用。
