Farcas Anca Otilia, Stoica Mihai Ciprian, Voidazan Septimiu, Maier Ioana Maria, Maier Adrian Cornel, Suciu Horatiu, Sin Anca Ileana
Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania.
Department of Cell Biology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania.
Biomedicines. 2024 Oct 4;12(10):2258. doi: 10.3390/biomedicines12102258.
Heart transplantation (HT) remains the ultimate treatment for end-stage heart failure. An endomyocardial biopsy (EMB) is "the gold standard" diagnostic procedure used in HT rejection surveillance. The aim of this study is to provide a detailed analysis of the histopathological characteristics of the EMB and to investigate if there is a correlation between some histopathological changes, such as fibrosis, vasculitis, Quilty effect (Q.E.), myocytes damage, and the presence of episodes of acute rejection.
In this retrospective study, 200 EMBs were included, coming from 65 patients transplanted in the Emergency Institute for Cardiovascular Diseases and Transplantation (ICvDT) Targu Mures between 2012 and 2024. Fibrosis, vasculitis, Q.E., myocyte damage, etc., were microscopically evaluated to see if these parameters correlate with rejection episodes.
The mean age was 38.18 years (SD 15.67), 25% of biopsies being recorded in the 41-50 age group. 77.14% of total acute cellular rejection (ACR) was of mild rejection, with most registered in the 11-20 age group; the cases of severe rejection being recorded in the 41-50 age group. Antibody-mediated rejection (AMR) was recorded more frequently in women with a representation of 23.4%, compared to 8.5% of men. 86.7% (39 cases) of the total number of EMBs with fibrosis score 3 and 71.4% (15 cases) of the total EMBs with fibrosis score 2 were recorded in men, compared to the 28.6% (6 cases) of fibrosis score 2 recorded in women ( = 0.013). 50.0% of all the EMB recorded in the 61-70 age group showed fibrosis score 3, compared to 34.8% of those from the 21-30 age group. The Q.E. was identified in 13% of the biopsies and, in some patients, it was observed across 3-4 successive biopsies. Mild vasculitis was associated in 34.9% of cases with ISHLT ≥ 1R and moderate vasculitis was associated in 87.5% of cases with ISHLT ≥ 1R.
Fibrosis was detected much more frequently in men and in the 61-70 age group. In addition to the histopathological changes specific to acute rejection, there are other pathological changes, such as the Q.E., and vasculitis and myocytes damage and disarray, that seem to suggest a close connection with rejection, but extensive studies are needed to confirm this.
心脏移植（HT）仍然是终末期心力衰竭的最终治疗方法。心内膜心肌活检（EMB）是用于心脏移植排斥反应监测的“金标准”诊断程序。本研究的目的是对EMB的组织病理学特征进行详细分析，并调查某些组织病理学变化，如纤维化、血管炎、奎尔蒂效应（Q.E.）、心肌细胞损伤与急性排斥反应发作之间是否存在相关性。
在这项回顾性研究中，纳入了200份EMB，这些样本来自2012年至2024年在特尔古穆列什心血管疾病与移植急诊研究所（ICvDT）接受移植的65名患者。对纤维化、血管炎、Q.E.、心肌细胞损伤等进行显微镜评估，以查看这些参数是否与排斥反应发作相关。
平均年龄为38.18岁（标准差15.67），25%的活检记录在41 - 50岁年龄组。急性细胞排斥反应（ACR）总数的77.14%为轻度排斥反应，大多记录在11 - 20岁年龄组；重度排斥反应病例记录在41 - 50岁年龄组。抗体介导的排斥反应（AMR）在女性中记录更为频繁，占比23.4%，而男性为8.5%。纤维化评分为3的EMB总数中，86.7%（39例）为男性，纤维化评分为2的EMB总数中，71.4%（15例）为男性，而女性中纤维化评分为2的占28.6%（6例）（P = 0.013）。61 - 70岁年龄组记录的所有EMB中，50.0%显示纤维化评分为3，而21 - 30岁年龄组为34.8%。在13%的活检中发现了Q.E.，在一些患者中，在连续3 - 4次活检中均观察到。34.9%的病例中轻度血管炎与国际心脏和肺移植学会（ISHLT）≥1R相关，87.5%的病例中中度血管炎与ISHLT≥1R相关。
在男性和61 - 70岁年龄组中纤维化的检测更为频繁。除了急性排斥反应特有的组织病理学变化外，还有其他病理变化，如Q.E.、血管炎以及心肌细胞损伤和紊乱，这些似乎表明与排斥反应有密切联系，但需要广泛研究来证实这一点。
