Occurrence of circulating heart-reactive antibodies in a population of cardiac transplant recipients. Correlation with cardiac rejection and subsequent course.

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Abstract
To determine to what extent cardiac allograft transplantation induces the production of heart-reactive antibody or antibodies (HRA), pre- and postoperative sera were assayed from 68 cardiac transplant recipients. During the 1st postoperative mo., HRA was detected in 63% of transplant patients but in only 25% of 40 cardiac surgical controls (P < 0.01). The incidence of detectable preoperative HRA did not differ in the 2 groups (13% transplant vs. 10% nontransplant patients). To evaluate whether HRA may serve as a monitor of cardiac rejection, sera were analyzed during 90 episodes of rejection in 65 patients, as diagnosed by endomyocardial biopsy. HRA was present in 65% of 1st rejection episodes, 62% of all episodes and in at least one episode in 69% of patients rejecting. HRA generally rose before initial rejection, peaked near rejection and decreased gradually with rejection therapy. In many patients, HRA appeared to an early signal of posttransplant immune activation. A relatively neutral role for circulating HRA with respect to clinical outcome was suggested. Apparently HRA appears after cardiac transplantation, despite immunosuppression, in a frequency and intensity too great to be explained on the basis of pericardiotomy alone. HRA does not appear in all transplant patients during rejection episodes, so a rising HRA titer cannot be used as a sole clinical indicator of impending rejection.