Association of transforming growth factor ß1 (TGF- ß1) with gingival hyperplasia in heart transplant patients undergoing cyclosporine-A treatment.

BACKGROUND: Gingival hyperplasia is a common complication of immunosuppressive therapy with cyclosporine A (CyA). However, the association of CyA with increased tissue concentrations of TGF- ß(1), a potential causative factor of hyperplasia, remains unknown. The aim of the study was to assess the impact of TGF- ß(1) and IL-2 on the development and maintenance of gingival hyperplasia in patients treated with CyA after orthotopic heart transplantation (OHT). MATERIAL/METHODS: Gingival hyperplasia was indexed in 60 patients, in accordance with McGraw and Potter scale. Patients were divided and comparisons were made among 3 groups: Group A (18 patients; 49.0 ± 12.1 y/o) after OHT with gingival hyperplasia (score 1, 2, 3), Group B (12 patients; 40.0 ± 15.1 y/o) after OHT without gingival hyperplasia (score 0), and Group C - the control group - (30 patients; 42.0 ± 10.8 y/o) with clinically healthy paradentium. Cytokines (TGF- ß(1) and IL-2) were marked in gingival tissue homogenate. The concentration of CyA was marked in the patients' blood (Groups A and B). RESULTS: The highest mean concentration of TGF- ß(1) was obtained in Group A and the lowest concentration was in the control group. A positive correlation was found between TGF- ß(1) in gingival tissue and CyA blood concentration in Groups A and B. CONCLUSIONS: TGF- ß(1) is associated with gingival hyperplasia in patients treated with CyA after OHT procedure.

Quilty effect correlates with biopsy-proven acute cellular rejection but does not predict transplanted heart coronary artery vasculopathy.

BACKGROUND: The appropriate therapy after orthotopic heart transplantation (OHT) is determined by the results of endomyocardial biopsies (EMBs). The Quilty effect (QE) is a recognized cause of discrepancies in EMB grading, but its clinical implications remain unclear. In this study we assess the correlation of the QE with biopsy-proven acute cellular rejection (AR) and coronary artery vasculopathy (CAV). METHODS: We reassessed 5,361 EMB samples, obtained from 429 patients, based on QE occurrence and its impact on EMB score. Next, we divided all patients with at least 1 year of follow-up into two groups: a QE(+) group (n = 202, 58.7% of sample, 172 males/30 females, 44.8 +/- 12 years of age) and a QE(-) group (n = 142, 41.3% of sample, 124 males/18 females, 45.4 +/- 12 years of age), and compared AR and CAV occurrences. RESULTS: The QE was observed in 669 EMBs (12.5%), and at least 1 EMB with QE was found among the 231 patients (53.8%). The initial QE occurrence took place during the first 3 months after OHT in 68% of QE(+) patients, and >1 year post-OHT in 13% of patients. The average EMB score was significantly higher in QE(+) biopsies. A comparison of the two groups revealed a significantly higher number of AR episodes and number of patients with at least one episode of AR in QE(+) patients. There was no significant difference in number of CAV occurrences between groups. CONCLUSIONS: The QE seems to be a marker of the same increased immune system activity that can lead to AR. A relationship between QE and CAV was not supported by the present results.

Influence of panel reactive antibodies (PRA) on perioperative course in patients undergoing elective cardiac surgery procedures, and impact of these procedures on PRA occurrence.

BACKGROUND: Cardiac surgery is supposed to be a risk factor of PRA formation, however the role of PRA presence in non-transplant subjects is not known. Aim of the study was to assess PRA occurrence in patients undergoing elective cardiosurgery procedures and to evaluate its influence on the perioperative course. MATERIAL AND METHODS: Blood samples were obtained before operation in 44 subjects (36M/8F; 55.9 +/- 8.1 y/o) undergoing primary elective cardiosurgery procedures--CABG (n = 30), CABG + valve (n = 2) or valve procedure (n = 12). PRA results were obtained after the discharge, and patients were retrospectively divided into: Group A (n = 18) with PRA > 1%, and Group B (n = 26) with PRA. < or = 1%. PRA screening was repeated 3 months after the procedure in 41 subjects. They were divided into Group I (n = 13) with PRA > 1%, and Group II (n = 28) with PRA < or = 1%. Comparison was performed of Groups A vs. B, and I vs. II. RESULTS: Differences in pre-operative characteristics and procedure type distribution were insignificant. Post-operative complications were more frequent in Groups A and I (pulmonary hypertension in Group I vs. II: 38 vs. 4%; p = 0.01). Duration of post-operative ICU stay was longer in Group I vs. 11 (2.9 vs. 1.9d.; p = 0.01). Overall hospital stay was longer in Group A vs. B (10.1 vs. 7.8d.; p = 0.054). Increase of PRA titers was observed in 10 subjects (3 pts. /17% from Group A, and 7 pts. /27% from Group B), exceeding 10% in 2 females after valve replacement. 6 months after procedure, detectable PRA was still observed in 7 patients. CONCLUSIONS: Cardiac surgery is not a strong causative factor of PRA formation. The presence of perceptible PRA level may be associated with increased incidence of complications and consequently prolonged in-hospital stay. Influence of PRA on peri-operative course is not dependent on the source of its increased level.