Lones M A, Czer L S, Trento A, Harasty D, Miller J M, Fishbein M C
Division of Anatomic Pathology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
J Heart Lung Transplant. 1995 Jan-Feb;14(1 Pt 1):151-62.
Humoral rejection is an infrequently reported, poorly understood form of cardiac allograft rejection.
We reviewed 81 consecutive heart transplant recipients followed up to 3 years after transplantation to evaluate the frequency and significance of humoral rejection in this population. Histologic features evaluated included capillary endothelial cell swelling, interstitial edema and hemorrhage, and neutrophilic infiltration. Immunofluorescence studies with antibodies to immunoglobulin G, immunoglobulin A, immunoglobulin M, Clq, C'3, HLA-DR, and fibrinogen and immunoperoxidase staining for endothelial cells (factor VIII-related antigen) and macrophages (KP1 [CD68]) were performed. Minimal criteria for the diagnosis of humoral rejection were capillary endothelial cell swelling and any immunoglobulin and complement staining in capillaries. Findings were graded and compared with concurrent hemodynamic measurements.
Immunoperoxidase staining showed that most swollen cells in capillaries were macrophages and fewer were endothelial cells. Humoral rejection was detected in 102 biopsy specimens from 42 patients (52%), within 3 weeks of transplantation in 28, and 3 weeks to 4 months later in the other 14 patients. One patient had evidence of humoral rejection almost 3 years after transplantation. A third of biopsy specimens with humoral rejection were associated with abnormal hemodynamics; of these 33 specimens only five had significant (grade 3 or 4) coexisting cellular rejection. Histologic findings most often associated with hemodynamic abnormalities were diffuse capillary endothelial cell swelling and any interstitial hemorrhage or edema. Three patients died of humoral rejection; only 1 had coexisting cellular rejection (grade 3A).
In our experience humoral rejection (1) is not uncommon (52% of patients), (2) is often (33% of cases) associated with hemodynamic abnormalities, and (3) may be fatal.
体液性排斥反应是心脏同种异体移植排斥反应中一种报道较少且了解不足的形式。
我们回顾了81例连续的心脏移植受者，对其进行了长达移植后3年的随访，以评估该人群中体液性排斥反应的发生率及意义。评估的组织学特征包括毛细血管内皮细胞肿胀、间质水肿和出血以及中性粒细胞浸润。采用针对免疫球蛋白G、免疫球蛋白A、免疫球蛋白M、Clq、C'3、HLA - DR和纤维蛋白原的抗体进行免疫荧光研究，并对内皮细胞（因子VIII相关抗原）和巨噬细胞（KP1 [CD68]）进行免疫过氧化物酶染色。体液性排斥反应的诊断最低标准为毛细血管内皮细胞肿胀以及毛细血管中有任何免疫球蛋白和补体染色。对结果进行分级，并与同时进行的血流动力学测量结果进行比较。
免疫过氧化物酶染色显示，毛细血管中大多数肿胀细胞为巨噬细胞，内皮细胞较少。在42例患者（52%）的102份活检标本中检测到体液性排斥反应，其中28例在移植后3周内检测到，另外14例在3周后至4个月检测到。1例患者在移植后近3年有体液性排斥反应的证据。三分之一有体液性排斥反应的活检标本与血流动力学异常有关；在这33份标本中，只有5份同时存在显著的（3级或4级）细胞性排斥反应。最常与血流动力学异常相关的组织学表现为弥漫性毛细血管内皮细胞肿胀以及任何间质出血或水肿。3例患者死于体液性排斥反应；只有1例同时存在细胞性排斥反应（3A级）。
根据我们的经验，体液性排斥反应（1）并不罕见（占患者的52%），（2）常（占病例的33%）与血流动力学异常有关，（3）可能是致命的。
