Heart transplant pathology
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:
- Findings seen in atherosclerosis.
Rejection
It comes in different flavours:
- Acute vascular rejection.
- Cellular rejection.
- Chronic rejection.
Acute vascular 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
- ↑ 1.0 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.
- ↑ Winters GL (March 1997). "The challenge of endomyocardial biopsy interpretation in assessing cardiac allograft rejection". Curr. Opin. Cardiol. 12 (2): 146–52. PMID 9192483.
- ↑ URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4. Accessed on: 7 January 2011.
- ↑ 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.
- ↑ 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.
- ↑ URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig5. Accessed on: 7 January 2011.
- ↑ URL: http://newsroom.ucla.edu/portal/ucla/ucla-team-uncovers-mechanism-behind-179330.aspx. Accessed on: 7 January 2011.