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Inflammatory Cytokines, Endothelial Function, and Chronic Allograft Vasculopathy in Children: An Investigation of the Donor and Recipient Vasculature After Heart Transplantation
- Source :
- American Journal of Transplantation. 16:1559-1568
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Chronic allograft vasculopathy (CAV) limits the lifespan of pediatric heart transplant recipients. We investigated blood markers of inflammation, endothelial dysfunction, and damage to both the native and transplanted vasculature in children after heart transplantation. Serum samples were taken from pediatric heart transplant recipients for markers of inflammation and endothelial activation. The systemic vasculature was investigated using brachial artery flow-mediated dilatation and carotid artery intima-medial hyperplasia. CAV was investigated using intravascular ultrasound. Mean intima-media thickness (mIMT)0.5 mm was used to define significant CAV. Forty-eight children (25 male) aged 8-18 years were enrolled in the study. Patients were a median (interquartile range) 4.1 (2.2-8.7) years after transplant. Patients had increased levels of circulating IL6 (3.86 [2.84-4.95] vs. 1.66 [1.22-2.63] p0.0001), vascular cell adhesion molecule 1 (539 [451-621] vs. 402 [342-487] p0.001), intracellular adhesion molecule 1 305 (247-346) vs. 256 (224-294) p = 0.002 and thrombomodulin (7.1 [5.5-8.1] vs. 3.57 [3.03-4.71] p0.0001) and decreased levels of tumor necrosis factor-α, E selectin, and P selectin, compared with controls. The systemic vasculature was unaffected. Patients with severe CAV had raised serum von Willebrand factor and decreased serum thrombomodulin. Posttransplant thrombomodulin levels are elevated after transplant but significantly lower in those with mIMT0.5 mm. This suggests that subclinical inflammation is present and that natural anticoagulant/thrombomodulin activity is important after transplant.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
Heart Diseases
medicine.medical_treatment
Inflammation
030204 cardiovascular system & hematology
030230 surgery
Thrombomodulin
Proinflammatory cytokine
Endothelial activation
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Risk Factors
Internal medicine
medicine.artery
Intravascular ultrasound
medicine
Humans
Immunology and Allergy
Pharmacology (medical)
Vascular Diseases
Endothelial dysfunction
Brachial artery
Heart transplantation
Transplantation
medicine.diagnostic_test
business.industry
Allografts
Prognosis
medicine.disease
Chronic Disease
cardiovascular system
Cardiology
Cytokines
Heart Transplantation
Female
Endothelium, Vascular
Inflammation Mediators
medicine.symptom
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 16006135
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- American Journal of Transplantation
- Accession number :
- edsair.doi.dedup.....0ddafb1242add4fc793a535190db38fb