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Myocardial ischemic-fibrotic injury after human heart transplantation is associated with increased progression of vasculopathy, decreased cellular rejection and poor long-term outcome

Mohamad H. Yamani, MD^*,*, Showkat A. Haji, MD^*, Randall C. Starling, MD, MPH, FACC^*, E. Murat Tuzcu, MD^*, Norman B. Ratliff, MD, Daniel J. Cook, PhD, Ashraf Abdo, MD, Tim Crowe, BS^*, Michelle Secic, PhD^*, Patrick McCarthy, MD and James B. Young, MD^*

^* Department of Cardiology, Kaufman Heart Failure Center, Cleveland, Ohio, USA
Department of Anatomic Pathology, Kaufman Heart Failure Center, Cleveland, Ohio, USA
Allogen Laboratory, Kaufman Heart Failure Center, Cleveland, Ohio, USA
Cardiothoracic Surgery, and Kaufman Heart Failure Center, Cleveland, Ohio, USA

View larger version (163K): [in a new window]   Figure 1 In vivo intravascular ultrasound images of left anterior descending artery of a cardiac allograft at a branching site at baseline (A) and one year after transplantation (B) showing severe intimal progression. CMIT = change in maximal intimal and medial thickness over one year; IVUS = intravascular ultrasound; MIT = maximal intimal thickness.

View larger version (154K): [in a new window]   Figure 2 A section of the myocardium (H&E stain) from a patient with ischemic injury complicated by the development of interstitial fibrosis.

View larger version (15K): [in a new window]   Figure 3 Bar diagram showing extent of progression of coronary vasculopathy in the first year after transplantation (as indicated by the change in maximal intimal and medial thickness, CMIT) in the different patient groups.

View larger version (17K): [in a new window]   Figure 4 Kaplan-Meier seven-year event-free survival in the different patient groups.

View larger version (16K): [in a new window]   Figure 5 Bar diagram showing average episodes of acute cellular rejection 3A (during the first year of transplantation) in the different patient groups.

View larger version (17K): [in a new window]   Figure 6 Bar diagram showing average biopsy score (during the first year of transplantation) in the different patient groups.

View larger version (17K): [in a new window]   Figure 7 Bar diagram showing percentage of patients with positive human lymphocyte antigens crossmatch in the different patient groups. FCXM = flow cytometry cross match.

View larger version (15K): [in a new window]   Figure 8 Bar diagram showing quantitative T-cell flow cytometry in the different patient groups. FCXM = flow cytometry cross match.

View larger version (18K): [in a new window]   Figure 9 Bar diagram showing quantitative B-cell flow cytometry in the different patient groups. FCXM = flow cytometry cross match.