Differences in immunoactivation between heart and liver transplanted patients

HEART and liver transplantation have become the treatment of choice in end-stage heart or liver failure. Advances in surgical technique and the introduction of cyclosporine A have improved survival following transplantation, but allograft rejection is still common and remains a major cause of morbidity and late graft failure. Transplantation results in the recipient’s immune activation, however, because of baseline immunosuppressive therapy only some recipients manifest clinical symptoms of rejection. Induction immunosuppression after heart and liver transplantation has mainly been based on regimens previously used in renal transplantation. Modern regimens use triple-drug treatment: cyclosporine or FK 506, prednisone, and azathioprine for almost all organ recipients without questioning basic differences in immunoactivation. Beta-2-microglobulin (B2m) is a low molecular weight protein associated with HLA class I antigens and is of value for immunologic monitoring. B2m has been shown to significantly increase after heart, liver, or renal transplantation without clinical evidence for rejection. The purpose of this study was to explore differences in immunoactivation between stable heart and liver transplanted patients to improve long-term monitoring and immunosuppressive therapy.