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Related Experiment Videos

Grade 2 cellular heart rejection: does it exist?

M C Fishbein1, G Bell, M A Lones

  • 1Division of Anatomic Pathology, UCLA/Cedars-Sinai Medical Center 90048.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|November 1, 1994
PubMed
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Focal moderate cellular rejection (Grade 2) in heart transplants may actually be Quilty B lesions. These findings suggest Grade 2 rejection does not require treatment, potentially improving patient outcomes.

Area of Science:

  • Cardiovascular Pathology
  • Transplant Immunology
  • Histopathology

Background:

  • Focal moderate cellular rejection (Grade 2) is defined by the International Society for Heart and Lung Transplantation based on endomyocardial biopsy findings.
  • Distinguishing Grade 2 rejection from other lesions like Quilty B is crucial for appropriate patient management and immunosuppression strategies.

Purpose of the Study:

  • To re-evaluate the classification of Grade 2 cellular rejection in cardiac allograft endomyocardial biopsies.
  • To determine the relationship between Grade 2 rejection lesions and Quilty B lesions.
  • To assess the clinical significance and hemodynamic impact of Grade 2 rejection.

Main Methods:

  • Review of 115 endomyocardial biopsy specimens, including those with Grade 2 rejection, Quilty A, and Quilty B lesions.

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  • Detailed histological examination using step sections and special stains for elastic tissue and collagen.
  • Immunohistochemical staining for T and B lymphocytes and histiocytes.

    • Main Results:

    • 32 out of 35 cases initially classified as Grade 2 rejection showed continuity with the endocardium, consistent with Quilty B lesions.
    • Immunohistochemical patterns were similar between Quilty B lesions and those initially diagnosed as Grade 2 rejection.
    • No hemodynamic abnormalities were observed in any of the studied biopsy groups, including Grade 2 rejection.

    Conclusions:

    • Most cases diagnosed as Grade 2 cellular rejection are likely Quilty B lesions.
    • Quilty B lesions are not typically associated with hemodynamic compromise and do not necessitate augmented immunosuppression.
    • Reclassification of Grade 2 rejection as Quilty B lesions may prevent unnecessary treatment intensification.