Chopra P, Joshi A, Talwar K K, Airan B, Srivastava S, Venugopal P
All India Institute of Medical Sciences, New Delhi, India.
Natl Med J India. 1997 Nov-Dec;10(6):264-9.
Cardiac transplantation has recently been started in India at the All India Institute of Medical Sciences, New Delhi. All transplants are monitored by right ventricular endomyocardial biopsies. This study describes our initial experience with the histopathological assessment of post-transplant endomyocardial biopsies.
Fifty-four endomyocardial biopsies from 8 transplanted hearts were reviewed. At least 3 haematoxylin-eosin and Masson trichrome stained sections were available on each biopsy. Special stains and immunohistochemistry were done as required. Biopsies were graded for rejection using the grading system of the International Society for Heart and Lung Transplantation. Infection, 'Quilty' effect, biopsy site, ischaemia and reperfusion injury were also assessed.
There was no evidence of rejection in 34 biopsies. Eleven biopsies showed mild rejection. Only 9/54 biopsies from 4 of the transplant recipients had clinically significant grades of rejection. Biopsy sites were present in 13/54 biopsies. Ischaemia was present in the first biopsy after transplantation in 4 recipients. There was no evidence of viral or parasitic infection. 'Quilty' lesions were seen in 14/54 biopsies from 5 transplant recipients. Four of these 5 recipients had 'Quilty' lesions on more than 1 biopsy.
The low rejection rate at our centre is consistent with reports from around the world. Endomyocardial biopsy has been a safe, convenient and useful method for diagnosing rejection and monitoring the postoperative course of cardiac transplants at our centre.
印度新德里全印医学科学研究所最近开始开展心脏移植手术。所有移植手术均通过右心室心内膜活检进行监测。本研究描述了我们对移植后心内膜活检组织病理学评估的初步经验。
回顾了来自8例移植心脏的54份心内膜活检标本。每份活检标本至少有3张苏木精-伊红染色和马松三色染色切片。根据需要进行特殊染色和免疫组织化学检查。采用国际心肺移植学会的分级系统对活检标本的排斥反应进行分级。同时评估感染、“奎尔蒂”效应、活检部位、缺血和再灌注损伤情况。
34份活检标本未发现排斥反应证据。11份活检标本显示轻度排斥反应。54份活检标本中只有来自4例移植受者的9份活检标本出现具有临床意义的排斥反应分级。54份活检标本中有13份存在活检部位问题。4例受者移植后的首次活检标本出现缺血情况。未发现病毒或寄生虫感染证据。54份活检标本中有14份来自5例移植受者的活检标本出现“奎尔蒂”病变。这5例受者中有4例在1次以上活检中出现“奎尔蒂”病变。
我们中心的低排斥反应率与世界各地的报道一致。心内膜活检一直是我们中心诊断排斥反应和监测心脏移植术后病程的一种安全、便捷且有用的方法。
