Paavonen T, Mennander A, Lautenschlager I, Mattila S, Häyry P
Department of Pathology and Cardiovascular Surgery, University of Helsinki, Finland.
J Heart Lung Transplant. 1993 Jan-Feb;12(1 Pt 1):117-22.
We have analyzed the autopsy material of 11 cardiac allograft recipients, whose grafts became nonfunctional less than 1 year after transplantation. All patients had received routine triple-drug immunosuppression. Two of these patients showed accelerated transplant arteriosclerosis; the graft loss was associated with strong intimal proliferative response affecting the first-order and second-order intramuscular branches of the major coronary vessels. Histologic evidence showed only a slight inflammatory reaction in the vascular adventitia. The media was mostly intact, and the internal elastic lamina showed occasional breaks. A very prominent inflammatory reaction was noted in the subendothelial space in the intima. Immunohistochemistry with monoclonal antibodies revealed that the luminal part of the intima was invaded by anti-leukocyte common antigen and anti-UCHL1 positive T lymphocytes, whereas the abluminal part consisted mostly of anti-smooth muscle alpha-actin-positive smooth muscle cells. We call this subendothelial accumulation of lymphocytes endothelialitis. The suggestion has been made that accelerated arteriosclerosis may be associated with cyclosporine treatment. Correlation with the recipient's cytomegalovirus status in this study suggests that cytomegalovirus infection may contribute to the development of endothelialitis and accelerated arteriosclerosis in heart transplant recipients.
我们分析了11例心脏移植受者的尸检材料，这些受者的移植物在移植后不到1年就失去了功能。所有患者均接受了常规的三联药物免疫抑制治疗。其中2例患者出现了加速性移植血管硬化；移植物丧失与严重的内膜增殖反应有关，该反应累及主要冠状动脉的一级和二级肌内分支。组织学证据显示血管外膜仅有轻微炎症反应。中膜大多完整，内弹性膜偶尔有断裂。在内膜的内皮下间隙观察到非常明显的炎症反应。用单克隆抗体进行免疫组织化学检测显示，内膜的管腔部分被抗白细胞共同抗原和抗UCHL1阳性T淋巴细胞浸润，而管腔外部分主要由抗平滑肌α-肌动蛋白阳性的平滑肌细胞组成。我们将这种淋巴细胞在内皮下的积聚称为内皮炎。有人提出加速性动脉硬化可能与环孢素治疗有关。本研究中与受者巨细胞病毒状态的相关性表明，巨细胞病毒感染可能促成心脏移植受者内皮炎和加速性动脉硬化的发展。
