Acute cellular rejection and antibody-mediated rejection in endomyocardial biopsy after heart transplantation: a retrospective study from a single medical center

作者：Li, Li; Duan, Xuejing; Wang, Hongyue; Wang, Qingzhi; Lu, Yang; Yan, Chaowu; Xu, Hongyu^*

来源：International Journal of Clinical and Experimental Pathology, 2017, 10(4): 4772-4779.

• Endomyocardial biopsy
• cardiac transplantation
• cellular rejection
• antibody-mediated rejection

Aims: Endomyocardial biopsy (EMB) is the routine procedure for monitoring the outcome of heart grafts. This article reports acute cellular rejection and antibody-mediated rejection after heart transplantation, as detected by EMB. Methods: We retrospectively evaluated 496 patients who underwent heart transplantation in Fuwai Hospital between August 2004 and June 2015. The EMB specimens were used for evaluating acute cellular rejection (ACR) and antibody-mediated rejection (AMR) by histopathology and immunohistochemistry. Results: Of 496 patients who underwent HTX, a total of 856 EMBs were performed in 261 patients. Among 850 myocardium biopsies, 425 (52.9%, 425/850) showed no evidence of ACR and AMR. ACR was seen in 345 EMBs (40.6%, 345/850) with mild rejection observed (grade 1R) in 318 cases (37.4%, 318/850), moderate rejection in 25 cases (2.9%, 25/850) EMBs and severe rejection (3R) in 2 cases (0.23%, 2/850). Antibody-mediated rejection (AMR) was found in 8 EMBs, including 5 AMR alone and 3 AMR mixed with ACR. CD68 positive macrophages were found in all 8 EMBs with AMR and C4d staining was positive in 6 cases (75.0%). S6RP and pS6K were positive in 7 (87.5%) and 5 (62.5%) EMBs with AMR separately. Conclusions: Intravascular macrophages are a sign of microvascular inflammation and the earliest evidence of antibody-mediated allograft injury. Phosphorylated S6RP has the highest sensitivity in diagnosis of AMR, followed by C4d and pS6K. C4d is still a useful marker for AMR diagnosis.

• 出版日期2017
• 单位中国医学科学院阜外医院