Chest
Volume 103, Issue 2, February 1993, Pages 449-454
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Serum Neopterin After Lung Transplantation

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Objective: Neopterin (N), a marker for activated cell-mediated immunity, was assayed in the sera of 44 lung recipients early and late after transplantation. The study was a prospective, blind clinical trial designed to evaluate the following: (1) the daily dynamics of the serum neopterin/creatinine (N/C) ratio during the first 3 weeks after transplantation; (2) the correlation between changes in the serum N/C ratio and episodes of rejection or infection; (3) the correlation between the serum N/C ratio and the concentration of serum soluble interleukin 2 receptor (sIL-2R), a marker of T-cell activation; and (4) the potential value of monitoring the serum N/C ratio during noninvasive long-term follow-up of lung recipients.

Methods: Sera from lung recipients were collected every day or every 2 days for the first 3 weeks after transplantation (22 patients) and before fiberoptic bronchoscopy and routine consultation (44 patients). The N concentrations were determined by radioimmunoassay and sIL-2R levels were measured using a sandwich enzyme immunoassay.

Results: Serum N/C is an early and sensitive marker of immune activation in the 21 days following transplantation. The N/C ratios during early rejections (815 ±182 µmol/mol) and infections (677 ±75 µmol/mol) were higher than those in patients with no complications (160 ± 32 µmol/mol). In contrast, the N/C ratio did not increase during rejection later after transplantation. More than 3 weeks after transplantation, an increase in the N/C ratio was specifically correlated with infections, mainly those due to cytomegalovirus (CMV) (control subjects, 132 ±12 µmol/mol; rejections, 163 ±25 µmol/mol; CMV pneumonia, 786 ±103 µmol/mol, p<0.001). The N/C ratio correlated with sIL-2R serum levels (r=0.625, p<0.001).

Conclusions: Our results indicate that more than 3 weeks after transplantation, the serum N/C ratio increases only in cases of infection, mostly CMV pneumonia. In contrast, both rejection and infectious complications are associated with an increased N production in the early postoperative period.

Section snippets

Patient Population

Forty-four patients (26 male, 18 female), aged 9 to 61 years, were studied from November 1989 to April 1991. They underwent single lung (6 patients), double lung (12 patients), or heart-lung transplantation (26 patients) between January 1987 and March 1991. All these patients were studied after the first 3 weeks after transplantation. Twenty-two of them underwent transplantation during the prospective study and were therefore studied during the early postoperative period (first 3 weeks after

Early Dynamic Changes of Serum N/C Ratio After Lung Transplantation

The variations of serum N/C ratio were followed for the first 21 days after transplantation in 22 long/heart-lung recipients (311 samples). A preoperative blood sample was available from 19 patients. The mean preoperative serum N/C ratios in these patients (87 ± 11 µmol/mol) were not different from the values observed in a normal blood donor population. The only patient with an elevated preoperative serum N/C ratio (patient 8, N/C = 240 µmol/mol) was febrile prior to transplantation (38°C) and

DISCUSSION

The aim of this study was to determine the dynamics of the serum N/C ratio after lung transplantation, and the variations of this ratio during major and frequent posttransplantation complications (allograft rejection, CMV pneumonia, and obliterative bronchiolitis). Overall, the serum N/C ratio was a sensitive but nonspecific marker of immune activation in the first 21 days following transplantation. We also showed that an increased N/C ratio later after lung transplantation was related to

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    Support by grants from the Association Française de Lutte contre la Mucoviscidose.

    Manuscript received February 4; revision accepted June 26.

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