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Pathologic features in long-term cardiac allografts
A M Pucci1, R D Forbes, M E Billingham
1Department of Pathology, Pavia University, Italy.
Insights
Long-term heart transplant survival shows graft coronary artery disease resembling natural atherosclerosis, not typical graft disease. No tested factors predicted graft survival or disease progression.
Area of Science:
- Cardiology
- Transplantation Immunology
- Pathology
Background:
- Orthotopic heart transplantation is a life-saving procedure.
- Graft coronary artery disease (GCAD) is a major cause of late graft failure.
- Understanding the pathology of GCAD in long-term survivors is crucial.
Purpose of the Study:
- To compare the pathologic conditions of coronary arteries in long-term heart transplant survivors (11-17 years) versus short-term survivors (2 years).
- To identify factors correlating with graft survival and disease in heart transplant recipients.
Main Methods:
- Comparative pathologic analysis of coronary arteries from six long-term and six short-term heart transplant survivors.
- Matching of recipient/donor age and sex, and immunosuppressive therapy (azathioprine and prednisone).
- Investigation of ischemic time, HLA typing, rejection episodes, lipid profiles, and coronary angiograms.
Main Results:
- Graft coronary disease was prevalent (10/12 cases) and a cause of graft failure (8/12).
- Long-term survivors exhibited coronary artery pathology resembling natural atherosclerosis, distinct from the concentric GCAD seen in short-term survivors.
- No investigated parameters (ischemic time, HLA, rejection, lipids, angiograms) correlated with graft survival or disease.
Conclusions:
- The histopathologic features of coronary artery disease differ between long-term and short-term heart transplant survivors.
- The distinct pathology in long-term survivors suggests a different disease process than typical GCAD.
- Current investigated factors are insufficient for predicting graft disease and survival in heart transplant recipients.
Abstract:
Pathologic conditions of six long-term orthotopic heart transplant survivors (11 to 17 years) was compared with a group of six similar heart transplant recipients surviving only 2 years. The two groups were matched as far as possible for age and sex of both recipients and donors and for immunosuppressive therapy (azathioprine and prednisone). Ischemic time, HLA-A, -B typing, acute rejection episodes, lipid profiles, and coronary angiograms were investigated in both groups. None of these parameters correlated with survival or disease of the graft. Graft coronary disease was present in 10 of 12 cases and caused graft failure in 8 of 12. All six long-surviving grafts and four of six surviving only 2 years showed occlusive coronary disease. The major difference in the two groups was in the pathologic condition of the coronary arteries in the long-term survivors, which more resembled that of naturally occurring atherosclerosis than the characteristic concentric graft coronary disease present in grafts surviving 2 years. Although the histopathologic features were different in the two groups, no investigated factor was useful in predicting graft disease and survival.