Abstract

Background: A relation between microvasculopathy observed in endomyocardial biopsies (EMBs) and clinical coronary vasculopathy (CAV) after orthotopic heart transplantation (OHT) remains controversial. Aim of the study was to find a potential relation between microvasculopathy features in late EMBs and clinically confirmed CAV in long-term OHT survivors.
Material/Methods: We performed a retrospective analysis involving 68 pts. in
whom OHT was performed before 1999 - CAV (+) group consisted of 37 pts.
(35M/2F, 45±11y/o, ischemic c-pathy in 57%) with established CAV (need for coronary angioplasty, myocardial infarction or CAV-related death), control group was composed of 31 pts. (24M/7F, 43±16y/o, ischemic c-pathy in 39%) with negative coronary angiography 10 years after OHT. Microvasculopathy was assessed in elective EMBs performed 12 and 36 months after OHT using the following features: presence of prominent endothelial cells, degeneration of the endothelium, thickening of the muscle layer, thickening of the basal membrane, presence of lymphocytes in the arteriolar wall without any other signs of rejection vasculitis, periarteriolar fibrosis, and an occluded arteriolar lumen. Rejection grades in analyzed EMBs were comparable in both groups.
Results: The only significant difference was observed in occurrence of thickening of the basal membrane which was present in 22% of pts. from CMV (+) group and 3% of individuals from the control group. All other features, both in 12 and 36 month EMB, were similarly distributed (including basal membrane thickening 36 months after OHT).
Conclusions: Microvasculopathy observed 12 and 36 months after OHT is not predictive for CAV development.

Keywords: Heart Transplantation