Immunologic monitoring in orthotopic cardiac transplantation

Prospective random donor transfusion

Mitchell Goldman, T. Mohanakumar, T. Wolfgang

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Using conventional immunosuppression, azathioprine, antithymocyte globulin (ATG), and prednisone, cardiac transplantation has achieved a 50%-70% 1-year graft survival. Although traditional immunologic monitoring of cardiac transplant recipients has been predicated on modulating the dosages of ATG using T-cell rosetting techniques, there is little evidence that monitoring in this form has affected graft survival. We endeavored to examine the effects of random donor buffy coat or packed cell transfusions on the ratios of helper/suppressor-cytotoxic cells and the relationship in changes in these ratios to ummunosuppression with ATG and to ultimate graft survival. Monitoring of OKT4/T8 ratios using monoclonal antibodies in this small number of patients suggests that prospective transfusion of 5-10 U of random donor buffy coat or packed red blood cells results in a decrease in the OKT4 cells population, which remains depressed after transplantation and immunosuppression. This is associated with a greater graft survival in the transfused patients. Buffy coat, when given as 5-10 U prospectively, seems to be highly sensitizing (4 of 6 patients), resulting in one hyperacute rejection while packed blood, although sensitizing, seems to be less so. Prospective transfusion should be limited to patients who have not previously been transfused or to patients who have not been transfused within 6 months to 1 year prior to transplantation and do not already have circulating cytotoxic antibodies. Patients who have greater than 5% PRA should always undergo prospective cytotoxic crossmatch prior to transplantation. Prospective random donor red blood cell transfusions show promise in increasing the success rate of orthotopic cardiac transplantation when azathioprine, ATG, and prednisone are used as immunosuppressive drugs.

Original languageEnglish (US)
Pages (from-to)1982-1984
Number of pages3
JournalTransplantation Proceedings
Volume15
Issue number3
StatePublished - Jan 1 1983
Externally publishedYes

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Immunologic Monitoring
Heart Transplantation
Antilymphocyte Serum
Tissue Donors
Graft Survival
Transplantation
Azathioprine
Prednisone
Immunosuppression
Erythrocyte Transfusion
Immunosuppressive Agents
Erythrocytes
Monoclonal Antibodies
T-Lymphocytes
Antibodies
Pharmaceutical Preparations
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation

Cite this

Immunologic monitoring in orthotopic cardiac transplantation : Prospective random donor transfusion. / Goldman, Mitchell; Mohanakumar, T.; Wolfgang, T.

In: Transplantation Proceedings, Vol. 15, No. 3, 01.01.1983, p. 1982-1984.

Research output: Contribution to journalArticle

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