Nr. 1 - 1. Quartal 1997

Differential Diagnosis of Acute Rejection and Infections in Heart Transplanted Patients: New Ways Using Cytokines and Procalcitonin as Markers

M. Staehler, P. Überfuhr, B. Reichart, C. Hammer

The median organ survival rate for one year is 84% in worldwide more than 16.800 heart transplanted patients. During this time 60% of the recipients do suffer from acute rejection (AR) and 31% from an infection. Viral infections (VI) comprise approximately 40%, bacterial and fungal infections (B/FI) 52%. Differential diagnosis especially of the start of infection and rejection is still difficult and not reliable. Overlapping events are the most serious problem. The task of this study was to develop a safe diagnostic procedure from the blood that allows the differentiation of bacterial and viral infections and AR. After heart transplantation (HTx) the cytokines IL-6, IL-10, TNFa, Neopterin and the prohormone Procalcitonin (PCT) were measured daily in 2 ml blood collected from 48 patients. The cellular compartment was used for the cyto-immunological monitoring (CIM).

Fungal, bacterial and protozoal infections showed elevated levels of PCT. AR only and viral infections induced no PCT. The cause of PCT reflects successful antibiotic therapy with a half-life of 29 h. Neopterin and IL-10 are not suitable for the differential diagnosis after HTx. IL-6 is elevated with infection and AR, with levels over 25 pg/ml at the beginning of an inflammatory period being correlated with infection and levels below this value being correlated with AR. TNFa does not differentiate between infection and AR. Trauma leads to elevated levels of IL-6 and TNFa. Steroidal therapy has no influence on TNFa and PCT but suppresses IL-6. The combination of the values of TNFa, IL-6 and PCT with the results of the CIM allows the sensible and specific differential diagnosis of bacterial infection from viral infection and AR. The adaptation of therapy should therefore lead to a higher survival rate.

Keywords:

Heart transplantation, infection, rejection, Procalcitonin, cytokines, IL-6, IL-10, TNFa, Neopterin, differential diagnosis

Kurztitel:

Staehler, M. et al. (1997) TxMed 1:44

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