Cuda Jonathan D, Baldwin William M, Steenbergen Charles, Judge Daniel P, Dropulic Lesia K, Halushka Marc K
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA.
J Heart Lung Transplant. 2007 Nov;26(11):1212-6. doi: 10.1016/j.healun.2007.07.032. Epub 2007 Sep 27.
Coronary artery vasculitis has been described as a rare lesion in the spectrum of transplant vasculopathy or as an extension of severe acute cellular rejection. We describe a patient, 6 years after orthotopic cardiac transplantation, who developed rapid heart failure and died despite aggressive treatment, minimal cardiac rejection (ISHLT Grade 1R), and no known transplant vasculopathy. Autopsy showed a diffuse and essentially complete necrotizing vasculitis of the entire coronary vasculature involving small, medium and large vessels, with extensive fat necrosis within the pericardial space. Macrophages of the M2 phenotype were found lining the major coronary vascular lumens and infiltrating their walls. The presence of the M2 macrophage phenotype supports transplant vasculitis as part of the chronic transplant vasculopathy continuum.
冠状动脉血管炎在移植血管病变范围内被描述为一种罕见病变，或被视为严重急性细胞排斥反应的扩展。我们描述了一名患者，在原位心脏移植6年后，尽管接受了积极治疗、心脏排斥反应轻微（国际心脏和肺移植学会1R级）且无已知的移植血管病变，但仍出现快速心力衰竭并死亡。尸检显示整个冠状动脉血管系统弥漫性且基本完全坏死性血管炎，累及小、中、大血管，心包腔内有广泛的脂肪坏死。发现M2表型巨噬细胞排列在主要冠状动脉管腔内并浸润其管壁。M2巨噬细胞表型的存在支持移植血管炎是慢性移植血管病变连续体的一部分。
