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Correlation of Vascular Reaction in Endomyocardial Biopsies with Micro- and Macrovascular Graft Vessel Disease after Heart Transplantation

Rudolf Meyer

Ernst Wellnhofer

Roland Hetzer

Graft Vessel Disease (GVD) is the predominant long-term complication after heart transplantation. The study tests the correlation of vascular reaction with micro- and macrovascular evidence of GVD in cardiac transplants. The authors studied 41 heart transplant patients (9 women, 32 men, mean survival 58 months), 15 with and 26 without any angiographic signs of GVD. Paraffin-embedded right ventricular endomyocardial biopsies (n = 272) were graded for vascular reaction (H&E staining), that is, endothelial cell swelling and vascular wall thickening (both grade 0–2). Immunhistochemical investigations for vascular smooth muscle cells (SMCs) (/actin, clone 1A4) were performed and evaluated by light microscopy. Patients with angiographic evidence of GVD had more microvascular endothelial cell swelling than patients without macrovascular GVD (P < 0.05). There was a positive correlation of -actin-positive microvessels with early posttransplant endothelial cell swelling (P < 0.05). In contrast, there was a positive correlation of -actin-positive microvessels early after heart transplantation, with endomyocardial vessel wall thickening in the later postoperative period (P < 0.05). Development of GVD in large and small coronary arteries may coincide. Proliferation of medial SMCs plays the dominant role in the pathogenesis of small vessel disease. The serial evaluation of microvascular status provides early evidence of pathologic alterations associated with GVD.

Key Words: heart transplantation • graft vessel disease • etiopathogenesis • vascular reaction • endothelial cells • smooth muscle cells

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