Unlike lymphodepletion, a decrease in platelet count following induction immunosuppressive therapy with polyclonal rabbit antithymocyte globulin (rATG) is deemed as an adverse event. However, this ...phenomenon may represent a particular rATG antirejection mechanism.
This retrospective single-center study included 156 patients who received a heart transplant (HTx) between 2010 and 2018. All patients received rATG induction therapy for 5 days. Absolute lymphocyte count (ALC) and platelet counts were assessed on days 0, 7, and 14 following HTx. The primary outcome of the study was the first occurrence of acute cellular rejection (ACR) defined as grade ≥ 1B within 24 months after HTx.
Both ALC and platelet counts decreased rapidly after induction. During the 24-month follow-up period, 17% of patients had ACR. Patients with ACR had significantly higher platelet count on day 7 (145 vs 104, P < .001) and higher ALC on day 14 (162 vs 130, P = .035) than those without rejection. Patients in the highest platelet count quartile showed more ACR (50% in quartile 4 vs 0% in quartile 1, P = .006) as well as a higher cumulative total rejection score. Univariate analysis showed that ACR was associated with platelet count on day 7, recipient age, and pretransplant cytomegalovirus IgG serology. In multivariable regression analysis, platelet count on day 7 was the most accurate predictor of ACR.
Lower platelet count after induction with rATG is associated with less ACR. This suggests platelet involvement in antirejection mechanisms of rATG and a possible rationale for targeting platelets in future immunosuppressive strategies.
•Platelet count after rabbit antithymocyte globulin induction is associated with heart transplant rejection.•Lower platelet count on day 7 but not day 14 is related to less allograft rejection.•This indicates platelet involvement in alloimmunity early after transplant.
Umjerenost u svemu – sportsko srce Reschner, Ana; Jakuš, Nina; Fabijanović, Dora ...
Medicus (Zagreb, Croatia : 1992),
10/2019, Volume:
28, Issue:
2 Tjelesna aktivnost
Journal Article
Peer reviewed
Open access
Brojna klinička istraživanja dokazala su jasne koristi tjelesne aktivnosti za kardiovaskularno, ali i opće zdravlje svakoga čovjeka. Tjelesna aktivnost izaziva fiziološki odgovor organizma koji ...dovodi do različitih prilagodba pojedinih organskih sustava, a primjer jedne od njih jest i sportsko srce – benigni i reverzibilni odgovor kardiovaskularnog sustava na ponavljanu i intenzivnu tjelesnu aktivnost. Neke bolesti miokarda mogu dijeliti slične elektrokardiografske, ehokardiografske i druge karakteristike sa sportskim srcem. Pravodobno prepoznavanje takvih bolesti ključno je za zaštitu zdravlja svih koji se bave intenzivnijom tjelesnom aktivnosti rekreativno ili profesionalno.
U bolesnika s kroničnom limfoproliferativnom bolesti (LPB) veća je učestalost nastanka sekundarnih neoplazma. Istodobna pojava limfoproliferativne neoplazme (LPN) i mijelodisplastičnog sindroma (MDS) ...vrlo je rijetka. Druga hematološka neoplazma dijagnosticira se slučajno tijekom kontrola ili pri dodatnim analizama zbog
nesukladnih kliničkih ili laboratorijskih nalaza. Prikazujemo dijagnostički postupak, tijek bolesti i liječenje 65-godišnje bolesnice s kroničnom limfoproliferativnom neoplazmom i MDS-om sa suviškom blasta tipa 2
(MDS-EB2). Vodeći nalaz bila je neutropenija, a tek su citološkim analizama koštane srži i periferne krvi dijagnosticirane navedene neoplazme. Liječenje jedne i druge hematološke neoplazme nije dalo zadovoljavajuće rezultate i MDS je progredirao u akutnu mijeloičnu leukemiju. U bolesnika s limfoproliferativnom neoplazmom i citopenijom
valja tragati za mogućim drugim uzrocima takvih aberantnih nalaza. Pri liječenju tih bolesnika razumno je liječiti dominantnu bolest.
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.
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