+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Acute vascular rejection of the coronary arteries in human heart transplantation: pathology and correlations with immunosuppression and cytomegalovirus infection

Acute vascular rejection of the coronary arteries in human heart transplantation: pathology and correlations with immunosuppression and cytomegalovirus infection

Journal of Heart and Lung Transplantation 10(5 Pt 1): 674-687

Prior studies of vascular rejection in transplanted human hearts have stressed the importance of accelerated coronary arteriosclerosis (chronic vascular rejection). We, however, have had four patients with sudden onset of acute heart failure within 90 days of transplantation who have died without significant myocardial interstitial rejection or the concentric intimal thickening with dense collagen that is typical of chronic vascular rejection. In contrast, the coronary arteries in our patients had a prominent lymphocytic infiltrate, a loosely organized intimal thickening composed of smooth muscle cells, and extensive endothelial injury. We believe that these changes define acute vascular rejection of the coronary artery. In 14 transplanted hearts obtained consecutively, at autopsy or at a second transplant procedure, graft failure was caused by acute coronary vascular rejection in six cases and by chronic coronary vascular rejection in one case. The remaining seven patients showed no evidence of vascular rejection and died primarily of sepsis. Cytomegalovirus (CMV) disease was present in 6 of 7 patients with vascular rejection, of which 43% were CMV-negative recipients of hearts from CMV-positive donors. The adoption of a triple-drug protocol, in which azathioprine was added to cyclosporine and prednisone, reduced the incidence of acute vascular rejection from 27% to 8%. We conclude that acute coronary vascular rejection may be initially seen as global cardiac ischemia in the absence of significant interstitial myocardial rejection. Further, acute vascular rejection should be pathologically distinguished from chronic vascular rejection, although both are probably stages in the natural history of immune-mediated vascular injury.

Please choose payment method:

(PDF emailed within 1 workday: $29.90)

Accession: 006986775

Download citation: RISBibTeXText

PMID: 1659903

Related references

Acute rejection, cytomegalovirus infection and endothelial dysfunction early after heart transplantation. Transplantation Proceedings 27(4): 2346-2348, 1995

Human cytomegalovirus and acute rejection after heart transplantation are not directly associated. Journal of Medical Virology 50(1): 59-70, 1996

Coronary arteries from human cardiac allografts with chronic rejection contain oligoclonal T cells: persistence of identical clonally expanded TCR transcripts from the early post-transplantation period (endomyocardial biopsies) to chronic rejection (coronary arteries). Journal of Immunology 165(6): 3469-3483, 2000

Prospective study of human betaherpesviruses after renal transplantation: association of human herpesvirus 7 and cytomegalovirus co-infection with cytomegalovirus disease and increased rejection. Transplantation 69(11): 2400-2404, 2000

Coronary artery vasculitis chronic vascular rejection reversed with increased immunosuppression following cardiac transplantation. European Heart Journal 8(ABSTR Suppl. 2): 96, 1987

On the relation between cytomegalovirus infection and rejection after heart transplantation. Transplantation 52(1): 162-164, 1991

Reversal of rejection-induced coronary vasculitis detected early after heart transplantation with increased immunosuppression. Journal of Heart Transplantation 8(5): 413-417, 1989

Origin of cells in the coronary intima during acute vascular rejection of the transplanted human heart. Journal of Heart and Lung Transplantation 11(3 Pt 1): 492-499, 1992

Immunosuppression induced by hepatitis C virus infection reduces acute renal-transplantation rejection. European Journal of Immunogenetics 25(Suppl. 1): 23, 1998

Increased incidence of acute graft rejection on calcineurin inhibitor-free immunosuppression after heart transplantation. Transplantation Proceedings 43(5): 1862-1867, 2011

Enhancement of cytomegalovirus infection and acute rejection after allogeneic lung transplantation in the rat. Transplantation 61(8): 1250-1260, 1996

Cytomegalovirus infection and acute cellular vascular rejection in the renal allograft. Laboratory Investigation 68(1): 118A, 1993

Effects of time and previous acute rejection episodes on coronary vascular reserve in human heart transplant recipients. Journal Of The American College Of Cardiology. 20(6): 1333-1338, 1992

Acute vascular rejection involving the major coronary arteries of a cardiac allograft. Journal of Heart Transplantation 7(3): 191-197, 1988