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https://doi.org/10.15836/ccar2019.224

Lower platelet count early after the heart transplantation is associated with lower rates of cellular-mediated rejection within 24 months after heart transplantation

Boško Skorić ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Dora Fabijanović ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Marijan Pašalić ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Ana Reschner Planinc ; Izola General Hospital, Izola, Slovenia
Hata Botonjić ; University of Zagreb School of Medicine, Zagreb, Croatia
Maja Čikeš ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Ivo Planinc ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Jure Samardžić ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Hrvoje Jurin ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Daniel Lovrić ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Hrvoje Gašparović ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Višnja Ivančan ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Davor Miličić ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

Sažetak

Background: Decrease in platelet count following the induction with polyclonal anti-thymocyte globulin
(ATG) is deemed as an adverse event, while decrease in lymphocyte count represents a therapeutic
goal1. Still, the effect on platelets may represent an important part of ATG anti-rejection mechanisms.
Patients and Methods: This was a retrospective single-center study of consecutive HTx (heart transplantation)
patients (pts) from February 2010 to February 2018 in University Hospital Centre Zagreb. All
pts received rATG (Thymoglobulin®) 1.5 mg/kg daily during the first 5 days. Complete blood count with
differential was assessed on days 0, 7 and 14 after HTx. The incidence of cellular-mediated rejection
(ACR) was monitored for two years after HTx. ACR was classified according to ISHLT classification from
1990 and expressed as ACR of grade 1B or higher (≥1B).
Results: A total of 159 pts were transplanted. Median age was 55 years (IQR, 47-62 years), 76% were male. A total of 27 pts (17 %) experienced
ACR ≥1B during 24 months. Pts with ACR of grade ≥1B had higher platelet count on day 7 (145 vs 104 x 103/μL, p<0.001). They also
had higher the absolute lymphocyte count (ALC) on the same day, but this did not reach statistical significance (162 vs 130 x 103/μL,
p=0.19) and there was no correlation between ALC and platelet counts on day 7 (Pearson’s correlation coefficient was 0.064, p=0.459).
Conversely, more rejection was observed in pts with higher ALC on day 14 (326 vs 190 x 103/μL, p=0.035), with a trend towards statistical
significance in the relationship with higher platelet count (210 vs 199 x 103/μL, P=0.076). In the univariate analysis, higher platelet
count on day 7, younger recipient age and negative pre-transplant Cytomegalovirus (CMV) IgG serology were found as predictors of the
ACR ≥1B in the first 2 years after HTx (Table 1). In multivariable model, platelet count on day 7 and pre-transplant CMV serostatus were
independent predictors of rejection. ROC analysis of the aforementioned model showed a satisfying AUC of 0.75.
Conclusion: Decrease in platelet count following the induction with rATG is strongly related to less graft rejection that is independent
from the lymphodepleting effect. This indicates the importance of platelet involvement in anti-rejection mechanisms of ATG induction,
and consequently a possible rationale for targeting platelets in future immunosuppressive regimens.

Ključne riječi

heart transplantation; platelet count; cellular-mediated rejection

Hrčak ID:

226694

URI

https://hrcak.srce.hr/226694

Datum izdavanja:

15.10.2019.

Posjeta: 745 *