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Ann Thorac Surg 1992;53:572-577
© 1992 The Society of Thoracic Surgeons

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Articles

Noninvasive detection of heart transplant rejection with positron emission scintigraphy

Departments of Cardiac and Thoracic Surgery, Pathology, and Radiology, Vanderbilt University Medical Center, Nashville, Tennesee, USA

^_* Address reprint requests to Dr Stewart, Department of Cardiac and Thoracic Surgery, The Vanderbilt Clinic, Rm 2973, Nashville, TN 37232-5734.

Positron emission tomography has recently been used to evaluate ischemic heart disease through changes in myocardial blood flow and carbohydrate metabolism. Positron-emitting tracers were evaluated for their ability to detect acute allograft rejection after heterotopic cardiac transplantation in the rat. Sham-operated controls, non-rejecting isografts, and rejecting allografts were evaluated. Decay-corrected uptake of ¹³NH₃ and ¹⁸F 2-fluoro 2-deoxyglucose (FDG) reflects blood flow and glucose flux, respectively. Histologic examination of rejecting allografts documented mild rejection at 4 days and severe acute rejection by 8 days. All isografts were free from rejection. Uptake of FDG is greater in rejecting allografts than in nonrejecting isografts during both severe rejection (2.4% ± 0.8% versus 0.77% ± 0.4%; p < 0.02) and mild rejection (2.1% ± 0.6% versus 0.4% ± 0.1%; p < 0.02). Uptake of NH₃ in severely rejected grafts is reduced compared with nonrejecting grafts (0.6% ± 0.3% versus 1.7% ± 1.1%; p < 0.02). There is no difference in NH₃ uptake during mild rejection (1.8% ± 0.7% versus 1.3% ± 0.3%; p > 0.05). Uptake of FDG and NH₃ in native hearts of animals from all experimental groups is not significantly different from that in sham-operated controls. Glucose may be a preferred metabolic substrate during rejection. Our data support a humoral mechanism for substrate preference during transplant rejection and a potential diagnostic role for positron emission tomography.

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