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Related Experiment Videos

Coronary blood flow does not decrease during allograft rejection in heterotopic heart transplants.

K Bando1, C D Fraser, V P Chacko

  • 1Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Md 21205.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|March 1, 1991
PubMed
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Cardiac allograft rejection in beagles was monitored using phosphorus 31 nuclear magnetic resonance spectroscopy (31P NMR) and coronary blood flow measurements. Immunosuppression weaning led to rejection, but augmented therapy improved graft bioenergetics and reduced rejection scores.

Area of Science:

  • Cardiovascular Surgery
  • Immunology
  • Biomedical Engineering

Background:

  • Cardiac allograft rejection is a significant clinical challenge.
  • Phosphorus 31 nuclear magnetic resonance spectroscopy (31P NMR) shows promise for diagnosing rejection.
  • Coronary blood flow changes are critical indicators of graft health.

Purpose of the Study:

  • To evaluate changes in coronary blood flow during cardiac allograft rejection.
  • To assess bioenergetic changes using 31P NMR during rejection.
  • To correlate graft ischemia with allograft rejection.

Main Methods:

  • 16 beagles received cervical cardiac allografts and were managed with varying immunosuppression protocols.
  • 10 dogs (NMR group) underwent 31P NMR to assess the phosphocreatine to inorganic phosphate ratio (PCr/Pi).

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  • 6 dogs (FLOW group) had magnetic flow probes on the left anterior descending coronary artery to measure coronary flow.
  • Graft evaluation included endomyocardial biopsy, lactate production, and left ventricular end-diastolic pressure.

    • Main Results:

    • Initial immunosuppression (7 days) effectively suppressed rejection (PCr/Pi = 70% of baseline, biopsy score = 2.0).
    • Weaning immunosuppression led to metabolic decay and increased rejection (day 10: PCr/Pi = 45% of baseline, biopsy score = 5.8; p < 0.05).
    • Augmented immunosuppression (4 days) improved PCr/Pi to 83% of baseline and reduced biopsy score to 3.2.

    Conclusions:

    • Cyclosporine and prednisone effectively suppressed early rejection.
    • Weaning immunosuppression triggers graft rejection, evidenced by metabolic and hemodynamic changes.
    • 31P NMR is a valuable tool for monitoring cardiac allograft bioenergetics and rejection.