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Epicardial and microvascular graft vessel disease in children
N E Hiemann1, E Wellnhofer, H Abdul-Khaliq
1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. hiemann@dhzb.de
Insights
Graft vessel disease (GVD) significantly impacts long-term survival in pediatric heart transplant recipients. Both microvascular and macrovascular GVD are common complications in these young patients.
Area of Science:
- Cardiology
- Transplantation Immunology
- Pediatric Medicine
Background:
- Graft vessel disease (GVD) is a major challenge affecting long-term outcomes in heart transplantation (HTx).
- The prevalence and characteristics of GVD in pediatric recipients require further investigation.
Purpose of the Study:
- To determine the incidence of epicardial and microvascular GVD in pediatric patients following heart and heart-lung transplantation.
- To assess the relationship between rejection, vascular changes, and GVD in this population.
Main Methods:
- Analysis of 137 coronary angiographies from 130 pediatric HTx and heart and lung transplant (HLTx) patients (aged 0-18 years).
- Evaluation of angiographic findings using the Stanford classification and assessment of minor vessel alterations.
- Microscopic examination of 397 endomyocardial biopsies (EMBs) for acute cellular rejection and vascular reactions.
Main Results:
- Moderate and severe acute cellular rejection were observed in 32.8% and 13.3% of EMBs, respectively.
- Microvascular changes, including endothelial cell swelling (33.5%) and vessel wall thickening (53.8%), were prevalent.
- Coronary angiography revealed significant macrovascular alterations: Stanford lesions (61.2%), peripheral obliterations (52.5%), diameter fluctuations (86.3%), and pathologic tapering (64.0%).
- Long-term survivors (≥5 years) exhibited high rates of both macrovascular (78%) and microvascular (67%) alterations.
Conclusions:
- Microvascular and macrovascular GVD are predominant complications in pediatric HTx and HLTx long-term survivors.
- These findings underscore the clinical significance of GVD in pediatric transplant recipients and the need for monitoring.
Aim:
Graft vessel disease (GVD) is one of the main limiting factors to long-term survival after adult heart transplantation (HTx). The incidence of epicardial and microvascular GVD in paediatric patients was studied.
Methods:
A total of 137 coronary angiographies from 130 paediatric HTx and heart and lung transplant (HLTx) patients (70 male, 60 female, aged 0-18 y) were evaluated according to the Stanford classification and its supplements (minor vessel alterations). In H&E stainings from right ventricular endomyocardial biopsies (EMB = 397), light microscopic diagnosis of acute cellular rejection (ISHLT classification) and vascular reaction (morphology of endothelial cells and vessel walls) was performed.
Results:
Moderate rejection was present in 32.8% and severe rejection in 13.3% of EMB. Microvascular EC swelling was found in 33.5% and vessel wall thickening in 53.8% of EMB. The results of the coronary angiographic investigations were: Stanford lesions = 61.2%, peripheral obliterations = 52.5%, diameter fluctuations = 86.3%, pathologic tapering = 64.0%, calcifications = 10.8%. Long-term survivors (> or =5 y) showed macrovascular alterations in 78% of cases and microvascular alterations in 67% of cases.
Conclusion:
The development of micro- and macrovascular GVD is one of the predominant complications in long-term survivors after paediatric HTx and HLTx.
