Heart transplant pathology

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Heart transplant pathology is a niche in cardiac pathology.

It comes in different flavours:

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

Overview - table

Types of rejection:[1]

Type (grade) Description Details Image
acute edema, dilated small vessels scant inflammation [1]
cellular (0R) normal no extravascular monocytes
cellular (1R) infiltrate, myocyte damage scant interstitial infiltrate (lymphoplasmic), scant damage mild
cellular (2R) space-occupying lesion diffuse interstitial infiltrate displaces parenchyma (lymphoplasmic), obvious damage mod., mod. 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) [2], [3]

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).

Acute rejection

Microscopic

Features:[2]

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

Image:

Cellular rejection

Grading scheme 2004/1990:[3]

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.[4]

Microscopic

Features:[5]

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

Images:

Notes:

  • Vague similar to atherosclerosis.

See also

References

  1. ↑ 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.
  2. ↑ URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4. Accessed on: 7 January 2011.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig5. Accessed on: 7 January 2011.
  6. ↑ 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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