Kemnitz J, Choritz H, Cohnert T R, Haverich A, Borst H G, Georgii A
Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Federal Republic of Germany.
J Heart Transplant. 1989 Jul-Aug;8(4):315-29.
The prognostic value as represented by the predictive implications of the histopathologic bioptic diagnosis in cardiac allografts was studied in a total of 3209 biopsies from 111 patients under triple-drug immunosuppressive therapy after transplantation during a period of more than 2 years (0 to 782 days). The application of the so-called Hannover classification in the histopathologic diagnosis of rejection has revealed that there are certain configurations of histopathologic changes that lead significantly more frequently to the forms of acute rejection (moderate or severe) that require therapy. These are mild acute rejection with retrogressive changes in myocytes and a late-resolving phase of acute rejection with a severe vasculopathy. In cases with the simultaneous presence of the chronic phase of rejection, a slight prolongation of the interval taken by the conversion of these two diagnoses into the therapy-requiring forms of acute rejection could be observed. On average, however, the time interval of conversion of mild acute rejection with retrogressive changes in myocytes and of the late-resolving phase of acute rejection with interstitial vascular reaction into the therapy-requiring forms ranges between 7 and 10 days. Thus a second biopsy should be performed within this time interval.
我们研究了心脏同种异体移植组织病理学活检诊断的预测意义所代表的预后价值，这些活检来自111例接受三联药物免疫抑制治疗的患者，共3209次活检，移植后随访超过2年（0至782天）。在排斥反应的组织病理学诊断中应用所谓的汉诺威分类法发现，某些组织病理学变化模式更常导致需要治疗的急性排斥反应（中度或重度）形式。这些是伴有心肌细胞退行性变化的轻度急性排斥反应和伴有严重血管病变的急性排斥反应晚期消退阶段。在同时存在排斥反应慢性期的病例中，可以观察到这两种诊断转变为需要治疗的急性排斥反应形式所需的时间间隔略有延长。然而，平均而言，伴有心肌细胞退行性变化的轻度急性排斥反应和伴有间质血管反应的急性排斥反应晚期消退阶段转变为需要治疗的形式的时间间隔在7至10天之间。因此，应在该时间间隔内进行第二次活检。
