Overview of Cardiac Allograft Pathology
Cardiac allograft pathology is quite similar the transplant pathology of other solid organ allografts. It is important to anticipate the histopathological changes based on the time after transplantation. Changes most commonly observed during the first two months after transplantation include preservation or ischemia/reperfusion, acute rejection, previous biopsy sites, and occasionally, opportunistic infections. Ischemia/reperfusion injury is most common in the first endomyocardial biopsy, which is usually obtained between one and two weeks after transplantation. Therapy-requiring acute rejection is also most common and most severe within the first 4 -6 weeks after transplantation. Thereafter, serious rejection is relatively uncommon. Since endomyocardial biopsies are routinely obtained at weekly or biweekly intervals during the first few post-operative weeks, pathology related to previous biopsy sites is also common during this early time period. Compared to kidney, liver and intestinal allografts, opportunistic infections such as viral infections by the Herpes family(HSV, CMV, EBV and HSV) rarely involve the heart allograft.
Histopathological findings in endomyocardial biopsies obtained late after transplantation are more limited than those seen early after transplantation. Although mild focal or diffuse rejection is relatively common, more serious, therapy-requiring moderate or severe rejection are distinctly uncommon. In contrast, Quilty lesions, or endomyocardial infiltrates(EI) are seen in a significant number of EMB obtained after long term survival. Other relatively common late changes observed include patchy or diffuse endocardial, interstitial or perivascular fibrosis.
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