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| |  Early Warning Sign Predicts Heart Transplant Rejection CHICAGO, IL. -- October 7, 1997 -- An early warning sign for coronary artery disease found in heart transplant patients may indicate higher risk for transplant rejection, according to an article in tomorrow’s issue of The Journal of the American Medical Association (JAMA). Carlos A. Labarrere, M.D., of Methodist Research Institute in Indianapolis, IN., and colleagues studied 121 patients who received heart transplants between 1988 and 1995 to assess coronary artery disease development and transplant failure. The researchers found transplant patients were at greater risk of developing coronary artery disease – the leading cause of transplant failure -- when they tested positive within three months after a heart transplant for the presence of two specific marker molecules -- known as ICAM-1 and HLA-DR -- in the inner lining of the coronary arteries. The researchers found the marker molecules during routine endomyocardial biopsy specimens performed to monitor the patients for transplant rejection. The finding could provide an early warning sign to physicians as patients who developed the marker molecules in the inner lining of the coronary arteries were four times more likely than those who did not to experience transplant rejection years down the road. Early detection of transplant recipients at risk of rejection could potentially help physicians modify treatment to prevent rejection, the researchers said. Of the 121 heart transplant patients studied, 78 were found to be positive for the presence of the two marker molecules in their coronary arteries and 43 were negative. Twenty of the 78 positive patients (25.6 percent) experienced rejection while only three (seven percent) of the 43 negative patients rejected their heart transplants. Although not all patients who were positive for marker molecules in their coronary arteries developed coronary artery disease, the researchers estimate the disease will occur in 92.8 percent of of these patients within five years after heart transplantation, the authors write. All patients who are negative for the marker molecules remain free of disease for the first 18 months after transplantation, as compared with only 43 percent of transplant patients who are positive. "However, our data suggest that, irrespective of the time when the disease developed, the expression of arterial/arteriolar endothelial ICAM-1/HLA-DR preceded the development of coronary artery disease," The researcher say early detection of transplant hearts prone to coronary artery disease is essential to institute new therapeutic approaches that can increase the success rates of transplants.
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