Vasculitides and eosinophils in endomyocardial biopsies as rejection predictors in heart transplantation

• Published in: Arquivos brasileiros de cardiologia Vol. 97; no. 2; pp. 163 - 170
• Main Authors: Cipullo, Reginaldo, Finger, Marco Aurélio, Rossi Neto, João Manoel, Contreras, Carlos Mendes, Poltronieri, Nádia Van Geen, Zamorano, Mabel de Moura Barros, Silva, Lílian Mary da, Chaccur, Paulo, Dinkhuysen, Jarbas Jackson, Stolf, Noedir Antônio Groppo
• Format: Journal Article
• Language: English; Portuguese; Spanish
• Published: Brazil 01-08-2011
• Subjects: Adolescent; Adult; Aged; Biopsy - methods; Cardiomyopathies - pathology; Cardiomyopathies - surgery; Child; Eosinophils - pathology; Epidemiologic Methods; Female; Graft Rejection - pathology; Heart Transplantation - pathology; Humans; Male; Middle Aged; Myocardium - pathology; Predictive Value of Tests; Systemic Vasculitis - classification; Systemic Vasculitis - pathology; Time Factors; Young Adult
• ISSN: 1678-4170

The clinical significance of vasculitides, ischemic lesions, Quilty effect and the presence of eosinophils in endomyocardial biopsies of heart transplantation recipients with mild rejection has yet to be established.
To verify whether these histological findings observed in endomyocardial biopsies (eosinophils, vasculitides, Quilty effect and ischemic lesions) are capable of predicting acute graft rejection.
A total of 1,012 consecutive endomyocardial biopsies were reevaluated; of these, 939 were classified as OR or 1R according to the Nomenclature of the International Society of Heart and Lung Transplantation of 2005 and divided in two groups: (1) Predictive biopsies: those that preceded acute rejection; and (2) Nonpredictive biopsies: those that did not precede acute rejection. We compared the occurrence of the following histological findings: vasculitides, ischemic lesions, Quilty effect and eosinophils between the groups by uni- and multivariate analyses.
The statistical analysis showed that the presence of severe vasculitides and eosinophils were the best predictors for future acute rejection, with the following odds ratios: 10.60 (95%CI: 3.62 - 31.06. p < 0.001) and 6.26 (95%CI: 3.16 - 12.43, p < 0.001).
Severe vasculitides and eosinophils in myocardial biopsies are the main predictive factors of acute graft rejection post-heart transplantation.