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Updated: Jun 9, 2025
Murine Heterotopic Heart Transplant Technique
Published on: July 8, 2014
Histopathological Characteristics of Percutaneous Endomyocardial Biopsy in Heart Transplant Rejection Surveillance: A
Anca Otilia Farcas1,2, Mihai Ciprian Stoica3,4, Septimiu Voidazan5
1Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania.
Insights
This study analyzed heart transplant biopsies, finding fibrosis more common in men and older adults. Other changes like Quilty effect and vasculitis may also indicate rejection episodes.
Area of Science:
- Cardiovascular Medicine
- Transplantation Immunology
- Pathology
Background:
- Heart transplantation (HT) is a critical treatment for end-stage heart failure.
- Endomyocardial biopsy (EMB) is the standard for monitoring HT rejection.
- Histopathological analysis of EMB is crucial for understanding rejection mechanisms.
Purpose of the Study:
- To analyze histopathological characteristics of EMBs in heart transplant recipients.
- To investigate correlations between specific histopathological findings and acute rejection episodes.
- To evaluate the role of fibrosis, vasculitis, Quilty effect, and myocyte damage in rejection surveillance.
Main Methods:
- Retrospective analysis of 200 EMBs from 65 heart transplant patients (2012-2024).
- Microscopic evaluation of fibrosis, vasculitis, Quilty effect (Q.E.), and myocyte damage.
- Correlation analysis between histopathological parameters and documented rejection episodes.
Main Results:
- Fibrosis was significantly more frequent in men (p=0.013) and in the 61-70 age group.
- Acute cellular rejection (ACR) was predominantly mild (77.14%), with severe cases in the 41-50 age group.
- Antibody-mediated rejection (AMR) was more prevalent in women (23.4%) than men (8.5%).
- Quilty effect (Q.E.) was present in 13% of biopsies, sometimes persisting across multiple samples.
- Mild and moderate vasculitis showed associations with International Society for Heart and Lung Transplantation (ISHLT) rejection grades ≥ 1R.
Conclusions:
- Fibrosis is a significant finding in EMBs, particularly in older men.
- Histopathological changes like Q.E. and vasculitis may be linked to rejection episodes.
- Further research is needed to fully elucidate the role of these findings in HT rejection surveillance.
Background:
Heart transplantation (HT) remains the ultimate treatment for end-stage heart failure. An endomyocardial biopsy (EMB) is "the gold standard" diagnostic procedure used in HT rejection surveillance. The aim of this study is to provide a detailed analysis of the histopathological characteristics of the EMB and to investigate if there is a correlation between some histopathological changes, such as fibrosis, vasculitis, Quilty effect (Q.E.), myocytes damage, and the presence of episodes of acute rejection.
Methods:
In this retrospective study, 200 EMBs were included, coming from 65 patients transplanted in the Emergency Institute for Cardiovascular Diseases and Transplantation (ICvDT) Targu Mures between 2012 and 2024. Fibrosis, vasculitis, Q.E., myocyte damage, etc., were microscopically evaluated to see if these parameters correlate with rejection episodes.
Results:
The mean age was 38.18 years (SD 15.67), 25% of biopsies being recorded in the 41-50 age group. 77.14% of total acute cellular rejection (ACR) was of mild rejection, with most registered in the 11-20 age group; the cases of severe rejection being recorded in the 41-50 age group. Antibody-mediated rejection (AMR) was recorded more frequently in women with a representation of 23.4%, compared to 8.5% of men. 86.7% (39 cases) of the total number of EMBs with fibrosis score 3 and 71.4% (15 cases) of the total EMBs with fibrosis score 2 were recorded in men, compared to the 28.6% (6 cases) of fibrosis score 2 recorded in women (p = 0.013). 50.0% of all the EMB recorded in the 61-70 age group showed fibrosis score 3, compared to 34.8% of those from the 21-30 age group. The Q.E. was identified in 13% of the biopsies and, in some patients, it was observed across 3-4 successive biopsies. Mild vasculitis was associated in 34.9% of cases with ISHLT ≥ 1R and moderate vasculitis was associated in 87.5% of cases with ISHLT ≥ 1R.
Conclusions:
Fibrosis was detected much more frequently in men and in the 61-70 age group. In addition to the histopathological changes specific to acute rejection, there are other pathological changes, such as the Q.E., and vasculitis and myocytes damage and disarray, that seem to suggest a close connection with rejection, but extensive studies are needed to confirm this.
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