Lymphocyte tissue culture studies on human heart transplant recipients. II. Screening the lymphocyte reactivity of the recipients in vitro.

Abstract

In view of the compelling evidence for a genetic control of the immune response in animal models, human heart transplant recipients during the last academic year were screened preoperatively for their cellular immune responsiveness in vitro. This was assessed as a response profile of the recipients' lymphocytes to a standard panel of stimulants including phytohemagglutinin, antithymocyte globulin, and soluble antigens, as well as donor cells in a two-way mixed lymphocyte culture. The object was to determine whether or not a variation (putatively genetic in origin) existed among the recipients in regard to their cellular immune reactivity, and whether this bore any relation to their post-transplant course. Of the 11 recipients screened, one had a hyperactive profile and this was clearly associated with a poor prognosis. Two out of the three recipients with a high spontaneous rate of transformation died, as did three out of five with a high response to antithymocyte globulin. Conversely, in all three eases where a hyporeactive profile was detected, this carried a good prognosis. Similar good post-transplant courses were associated with low mixed lymphocyte culture results in five out of six cases. No correlation was seen when phytohemagglutinin or soluble antigens were employed as in vitro stimulants, and no correlation was detected between the original cardiac disease and the tissue culture results.