Histology of in-stent restenosis in a transplanted heart

We report the case of a 32-year-old heart transplant recipient who suffered several episodes of early Grade IIIA rejection and, on serial coronary angiography, demonstrated aggressive allograft vasculopathy. Severe lesions in the right coronary and left obtuse marginal arteries were stented; however, the disease was progressive and, almost 6 years after heart transplantation, she was retransplanted, providing us with the opportunity to examine the histology of transplant in-stent restenosis. She remains well 1 year after a second heart transplant operation.