Predictive value of inducible endothelial cell adhesion molecule expression for acute rejection of XXXX cardiac allografts.

@entity1 @entity4725 @entity63 @entity4105 @entity2071
We conducted a prospective longitudinal study to determine the clinical significance of endothelial adhesion molecule expression in endomyocardial biopsies from @entity1 cardiac allografts. Ten to 18 (mean 13) consecutive allograft biopsies were obtained from 20 serial @entity1 transplant recipients over a one-year period. A total of 267 biopsies was examined. The expression of endothelial adhesion molecules @entity2071 ( @entity2071 ), @entity4725 ( @entity4725 ), and @entity4105 , as well as the presence of CD3+ T cell infiltrates was assessed by immunocytochemical staining of frozen sections. Separate specimens taken at the same time were analyzed histologically for @entity63 or rejection. @entity2071 --and, to a lesser extent @entity4725 --was expressed at low levels in normal biopsies. @entity4105 was only expressed in 15% of histologically normal biopsy specimens. @entity63 noted in the immediate posttransplant period was associated with increased expression of all three adhesion molecules. @entity4725 expression increased both with the degree of CD3+ T cell infiltrates (P < 0.001) and with the degree of rejection (P < 0.05). @entity2071 increased over constitutive levels in association with diffuse CD3+ infiltrates (P < 0.001) and with rejection (P < 0.05). @entity4105 was increased on occasional vessels in association with CD3+ infiltrates (P < 0.001), but was not associated with active rejection. Increases in @entity4105 were most likely to occur in biopsies just prior to rejection episodes (odds ratio 3.3), and were least likely to occur in biopsies following rejection (odds ratio 0.3). @entity2071 , but not @entity4725 , was also elevated in prerejection specimens. @entity4725 and @entity2071 declined in postrejection specimens. These data suggest a dynamic pattern in the expression of endothelial cell adhesion molecules during the course of cardiac allograft rejection. This study also suggests that endothelial @entity4105 expression may be a useful clinical marker of impending rejection. Finally, inducible @entity4725 expression may be a helpful adjunct in the diagnosis of ongoing acute rejection, and decreases in its expression may be indicative of successful antirejection therapy.
