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Hypersensitivity myocarditis in heart transplant candidates
M B Gravanis1, G L Hertzler, R H Franch
1Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Ga 30322.
Summary
Hypersensitivity myocarditis was found in 7% of explanted hearts for transplant, a previously unreported finding. Peripheral eosinophilia was common, but clinical detection was rare, suggesting underdiagnosis in heart transplant candidates.
Area of Science:
- Cardiology
- Immunology
- Transplantation
Background:
- Hypersensitivity myocarditis is a rare condition.
- Routine histologic examination of explanted hearts for transplantation is not standard practice for detecting this condition.
Purpose of the Study:
- To determine the incidence of hypersensitivity myocarditis in explanted hearts intended for transplantation.
- To investigate clinical and laboratory findings associated with hypersensitivity myocarditis in this patient population.
Main Methods:
- Histologic examination of 193 explanted hearts for heart transplantation.
- Review of clinical data, including peripheral eosinophilia and skin rash.
- Semi-quantitative grading of interstitial infiltrate severity.
Main Results:
- Hypersensitivity myocarditis was identified in 15 patients (7%) among the explanted hearts.
- None of the cases were clinically detected prior to transplantation.
- All affected patients exhibited peripheral eosinophilia within two weeks before transplantation.
- One patient presented with a rash suggestive of an allergic reaction.
Conclusions:
- Hypersensitivity myocarditis is an underrecognized condition in heart transplant candidates.
- Peripheral eosinophilia may be a key indicator of subclinical hypersensitivity myocarditis.
- Vigorous pre-transplant drug regimens, including antibiotics, may contribute to the high incidence observed.