Cardiac allograft pathology: A clinicopathologic correlation

The relationships among cardiac allograft pathology, clinical course, and results of endomyocardial biopsies in 55 transplanted adult hearts from 43 autopsies and 12 retransplants were studied. The mean survival was 8.9 months. All patients received cyclosporin-A immunosuppressive therapy. Histologic assessment of left and right ventricles (LV and RV) and coronary arteries allowed comparison of the following regions of each ventricle: endocardium, subendocardium, myocardium, epicardium, epicardial coronary arteries, and intramyocardial arteries. Histologic and clinical features were compared using Fisher's exact test. Survival curve analysis (Wilcoxon's rank sum test) for each histologic feature was performed to define a statistical image of the significant pathologic features of allografts with longer survival. Pathologic changes were similar in LV and RV. Cellular infiltrate was equivalent transmurally in both ventricles. Subendocardial changes in the right ventricle generally reflected the same pathologic changes elsewhere in LV and RV. A history of at least two rejection episodes correlated with a perimyocytic pattern of LV fibrosis. Infiltrate and fibrosis in the epicardium and irregularity of the epicardial-myocardial junction and were more frequent in longer-surviving allografts and correlated with myocardial and coronary artery pathology. No significant correlation was found between subendocardial or myocardial pathological changes and coronary artery pathology. The statistical model proved to be a useful approach to the study of large numbers of clinicopathologic variables and gave results that were pathologically sound.