Heart transplant pathology

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Heart transplant pathology is a niche in cardiac pathology.

Overview - table

Types of rejection[1]

Type (grade) Description Details Image
acute edema, dilated small vessels scant inflammation acute
cellular (0R) normal no extravascular monocytes
cellular (1R) infiltrate, myocyte damage scant interstitial infiltrate (lymphoplasmic), scant damage mild cellular
cellular (2R) space-occupying lesion diffuse interstitial infiltrate displaces parenchyma (lymphoplasmic), obvious damage mod. cellular, mod. cellular resolving
cellular (3R) disruption of normal arch. diffuse interstitial infiltrate disrupts parenchyma (lymphoplasmic & PMNs), fibre loss/damage
chronic concentric intimal thicking internal elastic lamina preserved (unlike atherosclerosis) chronic, chronic

Pitfalls[1]

Name Description Details Image
Quilty A endocardial/subendocardial B-lymphocytes (in clusters) benign behaviour clinically Quilty effect, Quilty effect
Quilty B B-lymphocytes (in clusters) +/-myocyte damage; benign behaviour clinically Quilty effect, Quilty effect
Old biopsy site hemosiderin-laden macrophages fibrosis/myocyte replacement old Bx site

Mimics

Biopsy site reaction

General

  • Can be confused for rejection.

Microscopic

Features:

  • Hemosiderin-laden macrophages.
  • +/-Fibrosis/myofibre loss-replacement.
  • +/-Scant inflammatory infiltration.

Image: Biopsy site (pathconsultddx.com).

Quilty

General

  • Can be confused for rejection.
  • Benign behaviour.

Microscopic

Features:

  • B-lymphocytes (in clusters).
  • Location:
    • Quilty A: Endocardial/subendocardial.
    • Quilty B: Endocardial/subendocardial + myocardium.
        • +/-Myocyte damage.[2]

Images:

Coronary atherosclerosis (ischemic injury)

General

  • Usu. early - related to atherosclerosis in the donor heart.
  • Not typically biopsied. (???)

Microscopic

Features:

Rejection

It comes in different flavours:

  • Acute vascular rejection.
  • Cellular rejection.
  • Chronic rejection.

Acute rejection

Microscopic

Features:[3]

  • Edema.
  • Dilated small vessels.
  • Scant inflammatory infiltrate.

Image:

Cellular rejection

Grading scheme 2004/1990:[4]

Grade 2004 Grade 1990 Description Details Image
0R 0 normal no extravascular monocytes
1R 1A infiltrate, myocyte damage scant interstitial infiltrate (lymphoplasmic), scant damage mild
1R 1B infiltrate, myocyte damage diffuse interstitial infiltrate (lymphoplasmic), focal damage
1R 2 infiltrate, myocyte damage diffuse interstitial infiltrate (lymphoplasmic), obvious damage
2R 3A space-occupying lesion diffuse interstitial infiltrate displaces parenchyma (lymphoplasmic), obvious damage mod., mod. resolving
3R 3B disruption of normal arch. diffuse interstitial infiltrate disrupts parenchyma (lymphoplasmic & PMNs), obvious damage
3R 4 disruption of normal arch. diffuse interstitial infiltrate disrupts parenchyma (lymphoplasmic & PMNs), fibre loss

Chronic rejection

General

  • AKA transplant arteriopathy or cardiac allograft vasculopathy.
  • Thought to be a form of accelerated atherosclerosis.[5]

Microscopic

Features:[6]

  • Concentric intimal thickening.
  • Preservation of internal elastic lamina.

Images:

Notes:

  • Vague similar to atherosclerosis.

See also

References

  1. ↑ 1.0 1.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 136-7. ISBN 978-0781765275.
  2. ↑ Winters GL (March 1997). "The challenge of endomyocardial biopsy interpretation in assessing cardiac allograft rejection". Curr. Opin. Cardiol. 12 (2): 146–52. PMID 9192483.
  3. ↑ URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4. Accessed on: 7 January 2011.
  4. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 136. ISBN 978-0781765275.
  5. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 137. ISBN 978-0781765275.
  6. ↑ URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig5. Accessed on: 7 January 2011.
  7. ↑ URL: http://newsroom.ucla.edu/portal/ucla/ucla-team-uncovers-mechanism-behind-179330.aspx. Accessed on: 7 January 2011.

External links

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