Summary
Endomyocardial biopsy provides a safe, reliable, morphologic index of acute rejection and has an important role to play in the management of patients in whom acute rejection occurs. Repeated endomyocardial biopsies are well tolerated, permitting monitoring of acute rejection in cardiac recipients. Some patients have undergone over 30 serial biopsies. Adequate sampling requires at least four pieces of tissue. The biopsies are graded in the following manner: (a) Mild acute rejection is characterized by a perivascular and mild interstitial infiltrate of pyroninophilic lymphoblasts wihtout myocyte necrosis. (b) Moderate acute rejection has an increased infiltrate extending into the interstitium and causing focal myocyte necrosis. This requires augmentation of immunosuppression. (c) Severe acute rejection, which is more difficult to reverse, includes a more prolific infiltrate with the addition of neutrophils, hemorrhage, and increased myocyte necrosis. (d) Ongoing acute rejection implies that the degree of acute rejection is the same, or worse, than the previous biopsy. (e) Resolving or resolved acute rejection shows reparative changes with diminishing or absent inflammatory infiltrate following treatment. Recipients treated with Cyclosporin-A develop rejection and respond to treatment more slowly than with conventional treatment. This group also develops endocardial infiltrates and a dose-related fine perimyocytic cardiac fibrosis. The endomyocardial biopsy is also useful in identifying infectious agents, for example, toxoplasmosis in cardiac recipients.
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Caves PK, Schultz WP, Dong D Jr, Stinson EB, Shumway NJ (1974) New instrument for transvenous cardiac biopsy. Am Cardiol 33: 264
Caves PK, Stinson EB, Billingham ME, Shumway NE (1975) Percutaneous transvenous endomyocardial biopsy in human heart recipients. Ann Thorac Surg 16: 325
Caves PK, Stinson EB, Billingham ME, Shumway NE (1974) Serial transvenous biopsy of the transplanted human heart: Improved management of acute rejection episodes. Lancet I: 821–826
Mason JW (1978) Techniques for right and left ventricular endomyocardial biopsy. Am J Cardiol 41: 887–892
Billingham ME (1979) Some recent advances in cardiac pathology. Hum Pathol 10: 367–386
Billingham ME (1980) Diagnosis of cardiac rejection by endomyocardial biopsy. Heart Transpl 1: 25–30
Billingham ME (in press) Histologic diagnosis of rejection: Differences in conventional and Cyclosporine-treated patients. Heart Transpl
Weintraub D, Billingham ME (submitted for publication) Lymphocyte subpopulations in cyclosporine-treated human cardiac rejection. Heart Transpl
Dawkins KD, Oldershaw PJ, Billingham ME, Hunt SA, Oyer PE, Jamieson SW, Popp RL, Stinson EB, Shumway NE (1984) Changes in diastolic function as a non-invasive marker or cardiac allograft rejection. Heart Transpl 3: 286–294
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Supported by the Clinical Heart and Heart-Lung Transplantation Grant HL 13108-15 from the National Heart, Lung and blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Billingham, M.E. Endomyocardial biopsy detection of acute rejection in cardiac allograft recipients. Heart Vessels 1 (Suppl 1), 86–90 (1985). https://doi.org/10.1007/BF02072369
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DOI: https://doi.org/10.1007/BF02072369