Immunology And Echocardiography Monitoring After Human Orthopic Heart Transplantation

Immunology and Echocardiography monitoringafter human Orthotopic Heart transplantation(Abstract)In I 967,Dr Burnard accomplished the first human orthotopic heart transplantation (OHT) and for the expansion use of Cyclosporine ,the improvement of operation method and perioperation therapy,the success of OHT has been greatly improved. The survival ratio of 1, 5 and 10 years after OHT have reached 79%, 63% and 48% respectively. OHT has become a practical method to treat end-stage heart disease. Till 1997, there have been 306 OHT centers and have taken more than 40,000 cases OHT.It is very important for immunosuppressive therapy after OHT.The doses of immunosuppressive agents that protect the heart from acute rejection (AR) would lead to a rise of opportunistic infections, malignancies and drug toxicities, while less doses would lead to allograft loss. One of the main causes of early death after 01-IT is AR.Trans-jugular vein endomyocardial biopsy has been widely accepted as the only "Gold Standard"to judge the AR after OHT , but clinical experiences also find the deficiencies of endomyocardial biopsy(EMB). How to evaluate the effect of the drug on body immuno-system and how to judge the AR early and correctly to determine whether to apply anti-AR therapy are very important. So it is must be essential to be performed to monitor body immuno-system and heart function for forcasting the AR and modulating the doses of the immunosuppressive agents.The main purpose of this study was to observe the lymphocyte subsets and echocardiography changes after OHT.I Lymphocyte subsets monitoring after OHTFrom July, 1995 to October,2000,we detected the lymphocytes subsets changes from peripheral blood of the patients and their relationship with AR within one month after OHT using flow cytometry(FCM).The results showed-6-that the levels of CD3+, CD4+, CD8+T lypsphocyte and CD4+/CD8"ratiodecreased significantly on the first posttransplant day and increased gfaduallyto the pretransplan leVel within one week, while CD3+T lymPhocyte countdecreased to the lowest level on the first day after operation and remainedlower than l000 ll l/l in the first postoperation week,no acllte rejectionsoccurred within the first week after operation. The first ePisode of rejectionoccurred on the 13rd day after operation,during the occurrence of AR, CD3t,CD4+T lymphocyte and CD4+/CD8 +ratio were lower than those ofpretransplant, but the results revealed that wth the increase of degree of theAR,CD3 +,CD4 t T lymphocyte decreased while CD8 + T lymphocyteincreased and CD4+/CD8+ratio decreased (l. l1 I 0. 23 vs1. 79 i 0. 70) .Blymphocyte (CD3--HLA-DR+ ) percentage in peripheraI blood lymPhocytesremain at a higher level,but rePresent the trqnd of decrease. The activated Tlymphocyte (CD3+HLA-DR+ ) decreased to the lowest level during the firstposttransplant week,while the silent T lymphocytes (CD3+HLA-DR-- ) \remain at a higher Ievel,and CD3"HLA-DR'/ CD3'HLA-DRf