Mixed Acute Cellular Rejection and Antibody Mediated Rejection in Heart Transplantation: A Retrospective Study in a Single Transplant Center

PurposeAim. The aim of the present study was to investigate the relationship between antibody-mediated rejection and acute cellular rejection in heart transplant patients.MethodsMaterial and Methods. We analyzed 1903 Endomiocardial Biopsy (EMBs) from 240 adult heart transplant patients performed from 2007 to 2012. H&E, C4d and CD68 of paraffin embedded sections were analyzed. We scored C4d and CD68 according to ISHLT 2011 classification and Acute cellular Rejction (ACR) according to ISHLT 1990 and 2005 . C4d EMBs positive were 182, with a prevalence of 6.4% in our population study. We calculated the rejection score and severe rejection score in all patients included in the study.ResultsResults. In C4d positive EMBs ACR 0 was 71/136 (52%), 1A 40/136 (29%), 1B 13/136 (10%) grade 2 1/136 (1%), 3A 8/136 (6%), 3B 3/136 (2%). In C4d negative group ACR 0 was 1070/1767 (61%), 1A 477/1767 (27%), 1B 41/1767 (2%), 2 42/1767 (2,3%), 3A 130/1767 (7,3%), 3B 7/1767 (0,4%). The severe rejection score was higher in C4d positive patients 0,49±0,50 vs C4d negative patients0,27±0,26 (p=0,04) . In patients with recurrent C4d positivity severe rejection score was higher 0,68±0,20 than in C4d negative patients 0,24±0,43 (p=0,015).ConclusionConclusions. ACR and AMR coexist in HTx patients and are strictly related. In C4d positive EMBs a diffuse pattern of ACR (1B and 3B) was more frequently observed compared to C4d negative EMBs. Higher severe rejection score in AMR patients indicates that the two types of rejection interact and represent a new distinct pathological entity. PurposeAim. The aim of the present study was to investigate the relationship between antibody-mediated rejection and acute cellular rejection in heart transplant patients. Aim. The aim of the present study was to investigate the relationship between antibody-mediated rejection and acute cellular rejection in heart transplant patients. MethodsMaterial and Methods. We analyzed 1903 Endomiocardial Biopsy (EMBs) from 240 adult heart transplant patients performed from 2007 to 2012. H&E, C4d and CD68 of paraffin embedded sections were analyzed. We scored C4d and CD68 according to ISHLT 2011 classification and Acute cellular Rejction (ACR) according to ISHLT 1990 and 2005 . C4d EMBs positive were 182, with a prevalence of 6.4% in our population study. We calculated the rejection score and severe rejection score in all patients included in the study. Material and Methods. We analyzed 1903 Endomiocardial Biopsy (EMBs) from 240 adult heart transplant patients performed from 2007 to 2012. H&E, C4d and CD68 of paraffin embedded sections were analyzed. We scored C4d and CD68 according to ISHLT 2011 classification and Acute cellular Rejction (ACR) according to ISHLT 1990 and 2005 . C4d EMBs positive were 182, with a prevalence of 6.4% in our population study. We calculated the rejection score and severe rejection score in all patients included in the study. ResultsResults. In C4d positive EMBs ACR 0 was 71/136 (52%), 1A 40/136 (29%), 1B 13/136 (10%) grade 2 1/136 (1%), 3A 8/136 (6%), 3B 3/136 (2%). In C4d negative group ACR 0 was 1070/1767 (61%), 1A 477/1767 (27%), 1B 41/1767 (2%), 2 42/1767 (2,3%), 3A 130/1767 (7,3%), 3B 7/1767 (0,4%). The severe rejection score was higher in C4d positive patients 0,49±0,50 vs C4d negative patients0,27±0,26 (p=0,04) . In patients with recurrent C4d positivity severe rejection score was higher 0,68±0,20 than in C4d negative patients 0,24±0,43 (p=0,015). Results. In C4d positive EMBs ACR 0 was 71/136 (52%), 1A 40/136 (29%), 1B 13/136 (10%) grade 2 1/136 (1%), 3A 8/136 (6%), 3B 3/136 (2%). In C4d negative group ACR 0 was 1070/1767 (61%), 1A 477/1767 (27%), 1B 41/1767 (2%), 2 42/1767 (2,3%), 3A 130/1767 (7,3%), 3B 7/1767 (0,4%). The severe rejection score was higher in C4d positive patients 0,49±0,50 vs C4d negative patients0,27±0,26 (p=0,04) . In patients with recurrent C4d positivity severe rejection score was higher 0,68±0,20 than in C4d negative patients 0,24±0,43 (p=0,015). ConclusionConclusions. ACR and AMR coexist in HTx patients and are strictly related. In C4d positive EMBs a diffuse pattern of ACR (1B and 3B) was more frequently observed compared to C4d negative EMBs. Higher severe rejection score in AMR patients indicates that the two types of rejection interact and represent a new distinct pathological entity. Conclusions. ACR and AMR coexist in HTx patients and are strictly related. In C4d positive EMBs a diffuse pattern of ACR (1B and 3B) was more frequently observed compared to C4d negative EMBs. Higher severe rejection score in AMR patients indicates that the two types of rejection interact and represent a new distinct pathological entity.