The Annals of Thoracic Surgery, Vol 42, 517-522, Copyright © 1986 by The Society of Thoracic Surgeons
T-lymphocyte analysis in cardiac allograft recipients treated with cyclosporine
A Kawaguchi, T Mohanakumar, HM Lee, JA Thompson and RR Lower
To assess the usefulness of circulating T-lymphocyte analysis in cardiac
transplantation, T helper (Th) and T suppressor-cytotoxic (Ts- c) subsets
were serially monitored in 33 cardiac allograft recipients treated with
cyclosporine. The short-term prognosis of their 47 treated rejection
episodes were retrospectively correlated with the changes in T-cell
subpopulations. The data indicate three main findings. Reversed Th to Ts-c
ratio (less than 1) was associated with a reduced incidence of rejection
onset and a benign clinical course after treatment for rejection. Reversed
Th:Ts-c ratio caused by antirejection therapy was associated with less
chance of recurrence during the rest of hospitalization, regardless of the
mode of therapy and irrespective of whether the rejection was primary or
recurrent. These changes were mainly mediated by a reduction in T helper
cells rather than changes in the T suppressor-cytotoxic subset or total T
cells. Titration of antirejection therapy based on these T-cell dynamics
may reduce either overtreatment or undertreatment. A prospective randomized
study seems warranted to evaluate this approach as an alternative to a
predetermined antirejection protocol.
