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Cellular allograft rejection affecting the donor aorta after combined heart-lung transplantation
C Knosalla1, M Hummel, R Meyer
1Deutsches Herzzentrum Berlin, Abteilung für Herz-, Thorax- und Gefässchirurgie, Berlin, Germany. knosalla@dhzb.de
Background:
Infectious pseudoaneurysms of the ascending aorta are a recognized major complication after heart-lung transplantation.
Method:
This report describes an unusual and previously unreported complication, that of cellular allograft rejection, which caused a pseudoaneurysm of the donor's ascending aorta in a patient who underwent combined heart-lung transplantation. Repair was performed by primary suture after mobilization of the aortic segments.
Result:
On histological examination the resected aneurysm showed evidence of proliferative vasculitis with perivascular infiltration of the vasa vasorum by mononuclear cells. The mononuclear cells were identified as CD4+ and CD8+ by immunohistological staining.
Conclusions:
This report shows that cellular allograft rejection may affect the donor aorta after heart-lung transplantation and may result in pseudoaneurysm formation, even under triple-drug immunosuppression after ABO-compatible allograft transplantation.
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