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Year : 1999  |  Volume : 1  |  Issue : 6  |  Page : 209-116

Pathology of heart transplantation an eleven -year experience

1 Institute of Pathology, Medical School, Second University of Naples, Naples, Italy
2 Institute of Cardiac Surgery, Medical School, Second University of Naples, Naples, Italy

Correspondence Address:
Attilio Renzulli
Via Aquila 144, 80143- Napoli
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Source of Support: None, Conflict of Interest: None

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Background and Methods We reviewed our eleven-year experience in cardiac transplantation. From January 1988 through July 1999, we performed 212 heart transplants (HT) in 210 patients at our Institution. Indications for HT included dilated cardiomyopathy in 102 patients (48.11%), coronary artery disease in 74 (34.91%), heart valve disease in 21 (9.9%), myocarditis in 6 (2.83%), hypertrophic cardiomyopathy in 3 (1.42%), restrictive cardiomyopathy in 3 (1.42%), allograft coronary artery disease (ACAD) in 2 (0.94%), and congenital heart disease in 1 (0.47%). Patients were followed up for 138 months. During the follow-up period, 1659 endomyocardial biopsies (EMBs) were performed. Diagnosis and grading of rejection were reported according to the guidelines of the 1990 Working Formulation in the diagnosis of heart and lung rejection. For each patient, we evaluated the evolution of rejection in order to establish whether further immunosuppressive treatment was indicated. Results EMBs showed no sign of rejection (grade 0) in 806 (48.58%) cases, grade 1A rejection in 581 (35.02%), grade 1B in 123 (7.42%) cases, grade 2 in 45 (2.72%). Such degrees of rejection usually regressed spontaneously or remained stable over time. Grade 3A rejection was found in 37 (2.23%) biopsies, grade 3B in 6 (0.36%), therefore additional immunosuppressive treatment was performed only in 43 cases. No case of severe rejection (grade 4) has been observed to date. Sixty-one biopsies (3.67%) were considered inadequate. Conclusions During the follow-up period, 71 patients died (mortality rate 33.81%). Postoperative mortality after HT was high within the first postoperative month, and slightly lower between the 1st and the 6th postoperative month. The survival curve shows a better trend after the 6th postoperative month. Causes of death included acute graft failure in 31 patients, sudden death in 11, infections in 10, chronic rejection (ACAD) in 5, neoplastic complications in 4, acute rejection in 3, other causes in 7. A strong association was found between ACAD (5 patients) and HCV (4/5 patients) and HCMV (5/5 patients) positivity, confirming the opinion that such viruses could play a role in the development of chronic rejection.

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