Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Arq Bras Cardiol. 2011 Aug;97(2):163-70. doi: 10.1590/s0066-782x2011005000069. Epub 2011 Jun 3.
The clinical significance of vasculitides, ischemic lesions, Quilty effect and the presence of eosinophils in endomyocardial biopsies of heart transplantation recipients with mild rejection has yet to be established.
To verify whether these histological findings observed in endomyocardial biopsies (eosinophils, vasculitides, Quilty effect and ischemic lesions) are capable of predicting acute graft rejection.
A total of 1,012 consecutive endomyocardial biopsies were reevaluated; of these, 939 were classified as OR or 1R according to the Nomenclature of the International Society of Heart and Lung Transplantation of 2005 and divided in two groups: (1) Predictive biopsies: those that preceded acute rejection; and (2) Nonpredictive biopsies: those that did not precede acute rejection. We compared the occurrence of the following histological findings: vasculitides, ischemic lesions, Quilty effect and eosinophils between the groups by uni- and multivariate analyses.
The statistical analysis showed that the presence of severe vasculitides and eosinophils were the best predictors for future acute rejection, with the following odds ratios: 10.60 (95%CI: 3.62 - 31.06. p < 0.001) and 6.26 (95%CI: 3.16 - 12.43, p < 0.001).
Severe vasculitides and eosinophils in myocardial biopsies are the main predictive factors of acute graft rejection post-heart transplantation.
在心脏移植受者轻度排斥反应的心肌活检中，血管炎、缺血性病变、Quilty 效应和嗜酸性粒细胞的临床意义尚未确定。
验证心肌活检中观察到的这些组织学发现（嗜酸性粒细胞、血管炎、Quilty 效应和缺血性病变）是否能够预测急性移植物排斥反应。
对 1012 例连续的心肌活检进行重新评估；其中，939 例根据 2005 年国际心肺移植学会命名法分为 OR 或 1R，并分为两组：（1）预测性活检：即发生在急性排斥反应之前的活检；（2）非预测性活检：即未发生在急性排斥反应之前的活检。我们通过单变量和多变量分析比较了两组间以下组织学发现的发生情况：血管炎、缺血性病变、Quilty 效应和嗜酸性粒细胞。
统计分析显示，严重血管炎和嗜酸性粒细胞的存在是未来急性排斥反应的最佳预测因素，其优势比分别为 10.60（95%CI：3.62-31.06，p<0.001）和 6.26（95%CI：3.16-12.43，p<0.001）。
心肌活检中严重的血管炎和嗜酸性粒细胞是心脏移植后急性移植物排斥反应的主要预测因素。
