Longitudinal evaluation of microvessel density in survivors vs. nonsurvivors of cardiac pathologic antibody-mediated rejection
Longitudinal evaluation of microvessel density in survivors vs. nonsurvivors of cardiac pathologic antibody-mediated rejection
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DOI：
10.1016/j.carpath.2012.01.004
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发表时间：
2012-11-01
影响因子：
3.7
通讯作者：
Kfoury, Abdallah G.
中科院分区：
文献类型：
--
作者：
Revelo, Monica P.;Miller, Dylan V.;Kfoury, Abdallah G.
背景资料：心脏移植物的抗体介导的排斥反应（AMR）与移植物长期存活率降低有关，但并非所有AMR患者都会发生移植物过早衰竭。在一些抗体介导的排斥反应患者中，导致移植物失败的组织水平机制的特征很差。研究方法：我们使用CD34染色切片的全载片显微成像和计算机辅助图像分析评估了随时间推移肌内膜活检中心肌微血管密度（单位面积毛细血管数量）的变化。比较了8名心脏移植受者的变化，这些受者患有多次病理性AMR，死于心血管原因，8名年龄和性别匹配的病理性AMR患者在相似的随访时间间隔内仍然存活，6名匹配的对照组没有AMR或细胞排斥反应。结果如下：与移植后6个月和12个月的活检相比，病理性AMR和心血管死亡患者的末次活检（平均移植后6.52年）微血管密度降低[分别为-22%（P =.02）和25%（P =.02）]。其他组未观察到类似的下降。结论：心肌微血管密度显著降低确实发生在一部分预后较差的病理性AMR患者中。这些数据为AMR、微血管损伤和临床结局之间的相互作用提供了见解。(C)2012 Elsevier Inc. All rights reserved.
Background: Antibody-mediated rejection (AMR) of cardiac allografts is associated with reduced long-term graft survival, but not every patient with AMR develops premature graft failure. The tissue level mechanisms leading to graft failure in some patients with antibody-mediated rejection are poorly characterized. Methods: We assessed changes in myocardial microvessel density (number of capillaries per unit area) in endomyocardial biopsies over time using whole-slide microscopic imaging of CD34-stained slides and computer-assisted image analysis. Changes were compared among eight heart transplant recipients with multiple episodes of pathologic AMR who died from cardiovascular causes, eight age- and gender-matched patients with pathologic AMR who were still alive at a similar follow-up interval, and six matched controls without AMR or cellular rejection. Results: Microvessel density decreased in the last biopsies (mean 6.52 years post-transplant) from patients with pathologic AMR and cardiovascular mortality compared to their biopsies at 6 and 12 months post-transplant [respectively, -22% (P=.02) and 25% (P=.02)]. A similar decrease was not seen for the other groups. Conclusions: Significantly reduced myocardial microvessel density does occur in a subset of patients with pathologic AMR who have a worse outcome. These data provide insights into the interplay between AMR, microvascular injury, and clinical outcomes. (C) 2012 Elsevier Inc. All rights reserved.