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Graft vascular disease in the great vessels and vasa vasorum
M Fujita1, M E Russell, M A Masek
1Department of Pathology, Stanford University School of Medicine, CA.
Insights
Heart transplantation can lead to graft vascular disease in the aorta and pulmonary arteries. Intimal thickening in the aorta was significantly higher in transplant recipients, suggesting a risk of arteriosclerosis in great vessels after cardiac transplant.
Area of Science:
- Cardiovascular Pathology
- Transplantation Immunology
Background:
- Graft vascular disease (GVD) is a significant complication after solid organ transplantation.
- The involvement of great vessels, specifically the aorta and pulmonary arteries, in GVD post-cardiac transplant requires further investigation.
Purpose of the Study:
- To investigate the presence and extent of transplantation-associated arteriosclerosis in the aorta and pulmonary arteries following heart transplantation.
- To compare the morphometric changes in the great vessels of heart transplant recipients with control groups.
Main Methods:
- Histological examination of aorta and pulmonary artery sections from 19 cardiac explant cases.
- Comparison with control groups including autopsied hearts from non-cardiac transplant recipients and unused donor hearts.
- Morphometric analysis of the intima-to-media ratio in the aorta.
Main Results:
- Intimal proliferation was observed in the aorta and, to a lesser extent, in pulmonary arteries of heart transplant recipients.
- Vasa vasorum in both vessels showed intimal thickening, occlusion, or stenosis.
- The intima-to-media ratio in the aorta was significantly higher in the heart transplant group compared to controls (P < .01).
- Cytomegalovirus infection rate was higher in the heart transplant group (85%) versus controls (40%).
Conclusions:
- Heart transplantation is associated with arteriosclerosis in the great vessels, particularly the aorta.
- Intimal thickening in the aorta post-transplant is a notable finding, independent of cyclosporine use.
- The study highlights the potential for graft vascular disease to affect major arteries in cardiac transplant recipients.
Abstract:
To determine whether the great vessels were subject to transplantation-associated arteriosclerosis (graft vascular disease) we studied sections of aorta and pulmonary arteries from 19 cardiac explant cases. Sections of the same vessels from five autopsied hearts from patients who had received liver and/or kidney transplants with immunotherapy as well as from eight recipient hearts served as controls. In addition, eight donor hearts (three aortae and eight pulmonary arteries) that were not used for heart transplantation were examined. Intimal proliferation was noted in the aorta but affected the pulmonary arteries only slightly, whereas the vasa vasorum of both vessels were involved and were occluded or stenosed by thickened intima containing recanalized capillaries. On morphometric study the ratio of intima to media in the aorta was significantly higher in the heart transplant group than in the control group (0.14 +/- 0.14 [n = 19] v 0.02 +/- 0.02 [n = 16]; P < .01). This intimal thickening was not correlated with the use of cyclosporine or with other clinicopathologic factors. The cytomegalovirus infection rate was higher in the heart transplant group (85%) than in the control group (40%).