[Histologic diagnosis of rejection after heart transplantation].
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Abstract:
The author reconsiders Stanford classification which separates 3 degrees of rejection of transplanted hearts: minimal, moderate or severe rejection. This classification, widely used, was enriched with J. Kennitz's sub-varieties, based on more than 4,000 endomyocardial biopsies, performed on 132 patients who underwent heart transplantation. Interpretation of the histopathologic results of endomyocardial biopsies requires careful knowledge of simultaneous clinical or biochemical data. However, heart biopsy remains indispensible since it is the only test providing information on the presence or absence of cellular infiltrate and on myocardial fibers changes. The difficulties result from the very small size of all samples. Several types of rejection are illustrated and commented. However, the author's experience is presently restricted and hardly allows separating moderate rejections from minimal or severe rejections.Keywords:
Endomyocardial Biopsy
Graft rejection
Human heart
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Endomyocardial Biopsy
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Organ transplantation has kindled the human imagination since the beginning of time. Prehistorically, transplantation appeared as mythological stories: from creatures with body parts from different species, the heart transplant between two Chinese soldiers by Pien Ch’iao, to the leg transplant by physician Saints Cosmas and Damian. By 19th century, the transplantation concept become possible by extensive contributions from scientists and clinicians whose works had taken generations. Although Alexis Carrel is known as the founding father of experimental organ transplantation, many legendary names had contributed to the experimental works of heart transplantation, including Guthrie, Mann, and Demikhov. The major contribution to experimental heart transplantation before the clinical era were made by a team lead by Richard Lower and Norman Shumway at Stanford University in the early 1960s. They played the vital role in developing experimental and clinical heart transplantation as it is known today. Using Shumway biatrial technique Christiaan Barnard started a new era of clinical heart transplantation, by performing the first in man human-to-human heart transplantation in 1967. The techniques of heart transplant have evolved since the first heart transplant. This chapter will summarize the techniques that have been used in clinical heart transplantation.
Creatures
Human heart
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Endomyocardial Biopsy
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Endomyocardial Biopsy
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Endomyocardial Biopsy
Endocardium
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Immunosuppression
Endomyocardial Biopsy
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Background: Changes in the dosage of immunosuppressive drugs following organ transplantation, especially the heart, can be a potential predictor of long-term post-transplant outcomes. It may also be related to the degree of histopathological involvement of endomyocardium. Objectives: We aimed to evaluate cyclosporine and tacrolimus dose changes during post-transplantation biopsies and their association with endomyocardial biopsy grades. Methods: This retrospective study was performed on 100 cardiac transplant patients who underwent endomyocardial biopsies to assess graft stability. In the present study, the patients were divided into two groups receiving cyclosporine (13 cases) and tacrolimus (87 cases). The data was collected by reviewing the recorded files. Results: Regarding the administration of cyclosporine, at different times after biopsy, there was no significant relationship between the plasma level of the drug and the grade of biopsy. Concerning tacrolimus, there was a significant reverse association between serum concentration and biopsy grade at the first biopsy after transplantation (about one month after transplantation), although this relationship was not observed in the subsequent steps of biopsy. Also, the Quilty effect frequency was not significantly associated with biopsy grade in different biopsies for both drugs. Conclusions: There is a lack of association between endocardial biopsy grade in the heart and the serum level of cyclosporine after transplantation. However there is a significant reverse relationship between endomyocardial biopsy grade and serum Tacrolimus concentration in the first weeks after transplantation and thus monitoring serum Tacrolimus after transplantation may play an important role in predicting acute rejection.
Endomyocardial Biopsy
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