Predictive Value of Hematologic Parameters for Detecting Asymptomatic Graft Rejection After Heart Transplant:...

Hematologic parameters, such as mean platelet volume, red-cell distribution width, and neutrophil-to-lymphocyte ratio, have prognostic value in multiple cardiac conditions such as stable angina pectoris, acute coronary syndromes, and heart failure. However, no previous studies have evaluated the association between hematologic parameters and asymptomatic graft rejection after heart transplant. We evaluated the role of hematologic parameters for detecting asymptomatic graft rejection after heart transplant.

We retrospectively evaluated medical records of 47 adult patients who underwent orthotopic heart transplant between February 25, 2005, and July 6, 2014, in our hospital, noting their hematologic parameters before each biopsy. Two groups were created according to biopsy results: rejection and no-rejection.

We excluded 4 patients who died during the first month posttransplant owing to early complications. We evaluated 422 endomyocardial biopsy results of 43 adult patients (mean age, 43.4 ± 11.4 y; 14 women). Mean follow-up was 33 months. A total of 109 biopsies performed because of clinical suspicion of rejection were excluded. Red-cell distribution width levels were similar between groups (17.2% ± 2.6% in the rejection group and 17.1% ± 2.5% in the no-rejection group; P = .856). Neutrophil-to-lymphocyte ratio was similar between groups (7.8 ± 9.9 in the rejection group and 8.2 ± 9.7 in the no-rejection group; P = .791). Mean platelet volume levels were significantly lower in the rejection group (8.3 ± 1.3 fL) than in the no-rejection group (8.8 ± 1.8 fL) (P = .037) (Table 1).

According to our results, only lower mean platelet volume levels were significantly associated with asymptomatic graft rejection in patients with a transplanted heart. More detailed analyses are needed to exclude the effects of immunosuppressant drugs, and further studies are needed to clarify the exact role of hematologic parameters for detecting asymptomatic rejection after heart transplant.