• Pol. Arch. Med. Wewn. · Dec 2019

    Observational Study

    Fluctuations in circulating endothelial progenitor cell levels and acute cardiac graft rejection.

    • Tomasz M Rywik, Agata Braniewska, Ilona Kowalik, Małgorzata Firczuk, Katarzyna Kozar-Kamińska, Anna Wojciechowska, Anna Kasprzyk-Pawelec, Małgorzata Sobieszczańska-Małek, Przemysław Leszek, Piotr Rozentryt, and Tomasz Zieliński.
    • Heart Failure and Transplantology Department, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland. trywik@ikard.pl
    • Pol. Arch. Med. Wewn. 2019 Dec 23; 129 (12): 889-897.

    IntroductionEndothelial progenitor cells (EPCs) in nontransplant settings have reparative properties. However, their role in heart transplantation (HT) is not well defined.ObjectivesThe aim of this study was to prospectively evaluate changes in EPC levels in relation to post‑HT rejection.Patients And MethodsEPC levels were measured in 27 HT recipients for 6 months after HT. Acute cellular rejection (ACR) or antibody‑mediated rejection (AMR) were assessed by right ventricular endomyocardial biopsy.ResultsACR and AMR were observed in 7 (25.9%) and 6 (22.2%) patients, respectively. The ACR status at 1 month post‑HT did not differ with respect to EPC immediately post‑HT. At 1 month post‑HT in patients without ACR or AMR, EPC levels were significantly reduced compared with the measurements immediately post‑HT (P <0.001). On further follow‑up, EPC levels were similar regardless of the rejection events. Nonetheless, greater changes (coefficient of variation) in EPClog (logarithmic transformation) were associated with the risk of AMR or ACR compared with those without any rejection event (median [lower-upper quartile], 15 [13-18] vs 8 [5-13]; P = 0.02 and 22 [14-26] vs 8 [5-13]; P = 0.01, respectively). The receiver operating characteristic curve showed that the coefficient of variation of EPClog of 12 was the optimal cutoff value for the prediction of rejection (area under the curve = 0.85). Higher levels were associated with greater risk of ACR or AMR (P <0.005).ConclusionsEarly reduction of EPC levels was related to a lower risk of ACR or AMR. Greater changes of EPC‑levels during follow‑up were associated with a significantly higher risk of rejection.

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