Histopathological findings in cardiac transplant recipients: an assessment after 10 years' experience in Iran

For many patients with end-stage heart failure, cardiac transplantation remains the definitive therapeutic option. The first Iranian heart transplantation was successfully performed on July 8, 1993, at Dr Shariati Hospital, Tehran. This article reports the pathology of heart transplants performed in one decade at Dr. Shariati Hospital.

All individuals who underwent heart transplantation between July 1993 and July 2003 were studied for the pathology reports of endomyocardial biopsies of heart transplant recipients. One-month, 1-year, and 5-year survival rates are also presented.

Forty-five patients (14 females and 31 males) aged 29.6 +/- 12 years underwent heart transplantation. One-month, 1-year, and 5-year survival rates were 80%, 59.5%, and 50%, respectively. The grades of rejection were: 0 in 31 biopsies (24.2%); 1A in 27 (21.1%); 1B in one (0.8%); 2 in 21 (16.4%); 3A in 34 (26.6%); 3B in 9 (7%); 4 in four specimens (3.1%), and one biopsy was inadequate (0.8%). A Quilty B effect was observed in one specimen (0.8%), but a Quilty A effect, cytomegalovirus or toxoplasmic myocarditis, or previous biopsy sites were not observed.

Survival rates of heart transplant recipients were lower compared with the international statistics. The incidence and severity of rejection episodes were higher among our patients. These findings may be due in part to the noncompliance of heart transplant recipients with the follow-up biopsy schedules, leading to late detection of rejection episodes.