Alloreactive lymphoid infiltrates in human heart transplants: Loss of class II-directed cytotoxicity more than 3 months after transplantation

Abstract From 535 endomyocardial biopsies (87 heart transplant recipients) 283 cell cultures could be generated. All cultures tested contained T lymphocytes and in most cases CD4 was the predominant phenotype at any time posttransplant. A significantly higher proportion of CD8-dominated cultures was found among cultures from biopsies without myocytolysis. In the first 3 months post transplant 57% of cultures showed cytotoxicity against both class I and class II mismatched donor major histocompatibility complex (MHC) antigens, changing to an incidence of 33% at > 90 days. This proved to be due to a significant decrease in the number of cultures with human leukoctye antigen class II-directed cytotoxicity. This study shows that early after transplantation a heart transplant is infiltrated with activated donor-specific cytotoxic T cells which recognize a broad spectrum of mismatched donor MHC antigens, and that in time this spectrum becomes more restricted

Ventricular free wall rupture : sudden, subacute, slow, sealed and stabilized varieties

Six cases of acute myocardial infarction with blood in the pericardial sac are described. In one case rapid death followed myocardial rupture leaving no time for the possibility of intervention. Of two other cases acute symptoms developing after myocardial rupture, one was operated on promptly and the other, whose condition improved on pericardiocentesis, after a delay of a few hours. Both are now long term survivors A fourth patient probably had two episodes of rupture which apparently sealed off. He underwent cardiac catheterization, but no epicardial leak was found. Subsequently at operation a sealed myocardial rupture was detected and sutured over. The fifth patient suffered a silent myocardial rupture. A false aneurysm was diagnosed four months later and he withstood successful surgery. In the sixth patient, the course was similar to that of case 1, namely rapid death with a clinical picture suggestive of tamponade. Postmortem examination showed a covert rupture with some evidence of attempts to plug the opening. The purpose of this report is to emphasize the varying course which myocardial rupture can take

Arterial wall characteristics determined by intravascular ultrasound imaging: An in vitro study

The feasibility of assessing arterial wall configuration with an intravascular 40 MHz ultrasound imaging device was investigated in an in vitro study of 11 autopsy specimens of human arteries. The system consists of a single element transducer, rotated with a motor mounted on an 8F catheter tip. Cross sections obtained with ultrasound were matched with the corresponding histologic sections. The arterial specimens were histologically classified as of the muscular or elastic type. Muscular arteries interrogated with ultrasound presented with a hypoechoic media, coinciding with the smooth muscle cells. In contrast, the media of an elastic artery densely packed with elastin fibers was as echogenic as the intima and the adventitia. On the basis of the cross-sectional image, it was possible to determine the nature of the atherosclerotic plaque. The location and thickness of the lesion measured from the histologic sections correlated well with the data derived from the corresponding ultrasound images. This study indicates that characterization of the type of artery and detection of arterial wall disease are possible with use of an Intravascular ultrasound imaging technique

Treatment with cyclosporin and risks of graft rejection in male kidney and heart transplant recipients with non-O blood

In a consecutive series of 146 kidney transplant recipients treated with cyclosporin A a strong correlation between matching for the HLA-A, HLA-B, and HLA-DR loci specificities and outcome of the grafts was observed in male recipients with non-O blood groups. Such a beneficial effect of matching was not found in female patients or male patients with blood group O. In these patients survival of the grafts at one year was good irrespective of the number of HLA-A, B, and DR mismatches. Also in 47 male heart transplant recipients immune responsiveness against mismatched HLA antigens was related to blood group. A significantly higher incidence of rejection episodes was observed in male patients with non-O blood groups (n = 32) than in those with blood group O (n = 15). Matching for HLA-DR reduced the number of acute rejection episodes in male patients with non-O blood. These findings may help explain the controversial repor