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PMID: 1699422 Published · ppublish English Case Reports Journal Article

Accelerated arteriosclerosis in heart transplant recipients is associated with a T-lymphocyte-mediated endothelialitis.

The American journal of pathology ·Vol. 137 ·No. 4 ·1990-10-00 ·Pages 871-82

Hruban RH, Beschorner WE, Baumgartner WA, Augustine SM, Ren H, Reitz BA, Hutchins GM

Abstract

Accelerated arteriosclerosis has emerged as a major life-threatening complication in long-term survivors of heart transplantation. It has been proposed that accelerated arteriosclerosis is an immune-mediated complication of rejection. We observed a striking endothelialitis in the coronary arteries of two explanted hearts obtained from patients with severe transplant-related accelerated arteriosclerosis. This finding prompted us to review the pathologic changes in the coronary arteries of 23 autopsied patients who had received heart transplants. The infiltrate in these vessels was characterized using immunohistochemical stains for lymphocytes (CD45), macrophages (MAC-387), T lymphocytes (CD45RO), B lymphocytes (L-26), and smooth muscle cells (actin). In addition, a full panel of monoclonal antibodies was used on the fresh-frozen tissue available from one of the two explanted hearts. Ten of the eleven recipients with accelerated arteriosclerosis had a moderate to marked lymphocytic endothelialitis compared to 3 of 14 without transplant-related arteriosclerosis (P less than 0.005). Immunohistochemical staining of the paraffin-embedded material demonstrated that most of the lymphocytes in the subendothelial space of these vessels were T lymphocytes and that this infiltrate was associated with an accumulation of macrophages and a proliferation of smooth muscle cells in the intima. In the explanted heart from which fresh-frozen tissue was available for more detailed cell typing, the T cells marked predominantly as cytotoxic T lymphocytes (CD8+, CD2+). These results suggest that accelerated arteriosclerosis may be mediated, in part, by a cytotoxic T-lymphocyte-directed endothelialitis.

MeSH Terms
Adult Arteriosclerosis/etiology,pathology Coronary Vessels/pathology Endothelium, Vascular/pathology Frozen Sections Graft Rejection Heart Transplantation/adverse effects Humans Immunohistochemistry Male Middle Aged Myocarditis/etiology Organ Size Paraffin Staining and Labeling T-Lymphocytes
Chemicals
Paraffin
Authors & Affiliations
7 authors, click to expand affiliations / ORCID
Hruban R H
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Beschorner W E
Baumgartner W A
Augustine S M
Ren H
Reitz B A
Hutchins G M
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Article Info
Journal
The American journal of pathology
Abbr.
Am J Pathol
ISSN
0002-9440
Published
1990-10-00
Pages
871-82
Language
English
Region
United States
NLM ID
0370502
PMCID
PMC1877542
Subset
IM
External Links
PubMed source PMC Full Text View journal details
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