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Morphologische Befunde bei Herztransplantationen

Morphologic findings in heart transplantations

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Summary

The morphologic changes observed during the rejection of a transplanted heart take a principally similar course in experimental animals and in man. Hyperacute rejection of the transplanted heart is characterized by fibrin thrombi and aggregates of platelets which obstruct capillaries and arterioles. These changes are primarily the result of circulating antibodies. The acute rejection of a cardiac allotransplant is morphologically expressed in the myocardium by dense infiltrates consisting of mononuclear cells, monocytes or small lymphocytes, endothelial swelling, acute arteriitis, and disseminated cell necroses which can finally cause myocardial failure. The acute rejection crisis may be prevented by immunosuppressive therapy with cortisone derivatives, azathioprine, local irradiation and treatment with antilymphocytic globulin. The phase of chronic rejection is characterized by severe and usually obliterating intimal fibrosis of small and medium-size arteries as well as by interstitial fibrosis of the myocardium. Unspecific myocardial changes are ischemic and surgical-induced necroses and hemorrhages. In addition, the effects of denervation and interruption of the lymphatic vessels have to be considered. In cardiac transplants in man, severe atheromatous changes of the coronary arteries occur in the host. This severe atheromatosis of the coronary arteries is the result of immunologically induced endothelial processes and the influence of the persisting basic metabolic disease of the host as well as of long-term therapy with cortisone derivatives. Infections constitute the most serious complications of immunosuppressive therapy. Furthermore, the effects of cortisone, azathioprine and local irradiation on the myocardium are discussed.

Zusammenfassung

Die morphologischen Veränderungen bei der Abstoßung eines transplantierten Herzens verlaufen bei den verschiedenen Versuchstieren und beim Menschen prinzipiell in gleicher Weise. Bei der hyperakuten Abstoßung des Transplantates bilden sich Fibrinthromben und Thrombocytenaggregate, die die Capillaren und Arteriolen verschließen. Als Ursache kommen in erster Linie zirkulierende Antikörper in Betracht. Die akute Abstoßungsreaktion am transplantierten Herzen manifestiert sich morphologisch durch dichte Infiltration des Myokards mit mononucleären Zellen, Monocyten und kleinen Lymphocyten, Endothelzellschwellungen, eine akute Arteriitis und disseminierte Herzmuskelnekrosen, die schließlich die Insuffizienz des Herzens bedingen können. Durch eine geeignete immunsuppressive Therapie mit Cortisonderivaten, Azathioprin, lokaler Röntgenbestrahlung oder durch Behandlung mit Antilymphocytenserum kann die akute Abstoßungsreaktion unterdrückt werden. Die Phase der chronischen Abstoßung ist durch eine ausgeprägte, meist stenosierende Intimafibrose der kleinen und mittelgroßen Arterien und eine interstitielle Vernarbung des Myokards gekennzeichnet. Zu den unspezifischen Herzmuskelveränderungen gehören die ischämischen, operativ bedingten Herzmuskelnekrosen und Blutungen. Ferner sind die Einflüsse der Denervierung und der Unterbrechung der Lymphgefäße zu berücksichtigen. Bei den Herztransplantationen des Menschen wurden schwere atheromatöse Veränderungen an den Koronararterien des Empfängerherzens beobachtet. Diese schwere Atheromatose wird als Folge der immunbiologisch-induzierten Endothelprozesse und der persistierenden Grunderkrankung des Empfängers sowie der langdauernden Behandlung mit Cortisonderivaten aufgefaßt. Als Nebenreaktionen und Komplikationen der immunsuppressiven Therapie werden die Infektionen, die Wirkung von Cortison, Azathioprin und lokaler Röntgenbestrahlung auf den Herzmuskel erörtert.

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Literatur

  • Abbott, C. P., Lindsey, E. S., Creech, O., DeWitt, C. W.: A technique for heart transplantation in the rat. Arch. Surg.89, 645 (1964).

    PubMed  Google Scholar 

  • Bachmann, G. W., Fritsch, H., Rapp, W.: Immunologische Untersuchungen zum Postkardiotomiesyndrom. Verh. dtsch. Ges. inn. Med.74, 545 (1968).

    PubMed  Google Scholar 

  • —— Rapp, W.: Autoantikörpernachweis bei Herzerkrankungen unter Verwendung der indirekten Immunfluoreszenz. Verh. dtsch. Ges. inn. Med.73, 756 (1967).

    PubMed  Google Scholar 

  • Barnard, C. N.: A human cardiac transplant. S. Afr. med. J.41, 1271 (1967).

    PubMed  Google Scholar 

  • —— A human cardiac transplantation. Amer. J. Cardiol.22, 584 (1968).

    PubMed  Google Scholar 

  • —— Human heart transplantation. The diagnosis of rejection. Amer. J. Cardiol.22, 811 (1968).

    PubMed  Google Scholar 

  • Bednarik, B., Peresty, S., Tomecek, J., Vasku, J., Bednar, O., Hoffmann, K.: Unsere Erfahrungen mit der Herztransplantation beim Hunde. Wiederbelebung5, 45 (1968).

    Google Scholar 

  • Berenbaum, M. C.: Immunosuppressive agents. In: Organ transplantation F. Largiader, ed. Stuttgart: Thieme 1970.

    Google Scholar 

  • Bieber, C. P., Stinson, E. B., Shumway, N. E.: Pathology of the conduction system in cardiac rejection. Circulation39, 567 (1969).

    PubMed  Google Scholar 

  • —— —— —— Payne, R., Kosek, J.: Cardiac transplantation in men. 7. Cardiac allograft pathology. Circulation41, 753 (1970).

    PubMed  Google Scholar 

  • Bing, R. J., Chiba, C., Chrysohou, A., Gudbjarnason, S., Wolf, P. L.: Metabolic, histologic, and histochemical aspects of the homografted heart. Trans. Ass. Amer. Physicans74, 318 (1961).

    Google Scholar 

  • Blumenstock, D. A.: Response of heart transplants to immunosuppressive therapy in heart substitutes. Springfield: Thomas 1966.

    Google Scholar 

  • —— Hechtmann, H. B., Collins, J. A., Jaretzki, A., Hosbein, J. D., Zingg, W., Power, J. H.: Prolonged survival of orthotopic homotransplants of the heart in animals treated with methotrexate. J. thorac. cardiovasc. Surg.46, 616 (1963).

    PubMed  Google Scholar 

  • Bui-Mong-Hung, Liacopoulos, P., Vigano, M., Leandri, J.: Homotransplantation hétérotopique de coeur chez le rat: étude des stades initiaux du rejet et influence de la conservation. Europ. Surg. Res.1, 103 (1969).

    Google Scholar 

  • Chachera, J. P., Lacombe, M., Bui-Mong-Hung, Lacassagne, J. P., Crepin, Y., Hattaway, A.: Allogenic grafts of the heart in dogs treated with an antidog lymphocyte serum or globulin. Europ. Surg. Res.1, 26 (1969).

    Google Scholar 

  • —— —— —— Leandri, J., Harada, S., Dubost, C.: Azathioprine et survie après homotransplantation orthotopique du coeur conservé chez le jeune chien. Advanc. Transpl.1, 667 (1967).

    Google Scholar 

  • Carrel, A., Guthrie, C. C.: The transplantation of veins and organs. Amer. Med. (Philad.)10, 1101 (1905).

    Google Scholar 

  • Chatty, M. E., Deodhar, S. D.: Myocardial changes and kidney transplantation: lesions in patients receiving immunosuppressive therapy. Arch. Path.88, 602 (1969).

    PubMed  Google Scholar 

  • Chiba, C., Wolf, R. L., Gudbjarnason, S., Chrysohou, A., Ramos, H., Pearson, B., Bing, R. J.: Studies on the transplanted heart, its metabolism and histology. J. exp. Med.115, 853 (1962).

    PubMed  Google Scholar 

  • Childe, W. M., Morris, A. S.: Heart transplant rejection in pig and dog. Brit. J. Surg.56, 630 (1969).

    Google Scholar 

  • Cleveland, R. L., Lower, R. R.: Transplantation of canine cadaver hearts after short-term preservation. Transplantation5, Suppl. 904 (1967).

    PubMed  Google Scholar 

  • Cooley, D. A., Bloodwell, R. D., Hallman, G. L.: Cardiac transplantation for advanced heart disease. J. cardiovasc. Surg. (Torino)9, 403 (1968).

    Google Scholar 

  • —— —— —— Leachman, R. D., Nora, J. J., Milam, J. D.: Cardiac transplantation: general considerations and results. Ann. Surg.169, 892 (1969).

    PubMed  Google Scholar 

  • —— —— —— —— —— Rochelle, D. G., Milam, J. D.: Human cardiac transplantation. Circulation39, Suppl. I, 3 (1969).

    PubMed  Google Scholar 

  • —— Hallman, G. L., Liotta, D., Lechman, R. D., Messmer, B. J.: Cardiac replacements: current status of cardiac transplants and protheses. Ann. intern. Med.73, 677 (1970).

    PubMed  Google Scholar 

  • Cooper, D. K. C.: Experimental development of cardiac transplantation. Brit. med. J.1968 IV, 174.

    Google Scholar 

  • Cooper, T., Hirsch, E. F., Willman, V. L., Hanlon, C. R.: Transplantation of the heart. Alterations in morphology of the heart. Arch. Surg.89, 915 (1964).

    PubMed  Google Scholar 

  • Copeland, J., Kosek, J. C., Hurley, E. J.: Early functional and ultrastructural recovery of canine cadaver hearts. Circulation37, Suppl. II, 188 (1968).

    Google Scholar 

  • Dammin, G. J.: The pathology of human renal transplantation. In: Human transplantation. Rapaport and Dausset, eds. New York: Grune & Stratton 1968.

    Google Scholar 

  • DeBakey, M. E., Diethrich, E. B., Glick, G., Noon, G. P., Butler, W. T., Rossen, R. D., Liddicoat, J. E., Brooks, D. K.: Human cardiac transplantation: clinical experience. J. thorac. cardiovasc. Surg.58, 303 (1969).

    PubMed  Google Scholar 

  • Demikhov, V. P.: Lecture in problems of thoracic surgery. 1947. Medgiz. 1949.

  • —— Experimental transplantation of vital organs. New York: Consultants Bureau 1962.

    Google Scholar 

  • Dempster, W. J.: Atheroma in a transplanted heart. Lancet1969 II, 1247.

    Google Scholar 

  • —— The dilemma of the rejecting heart transplant. Amer. Heart J.78, 581 (1969).

    PubMed  Google Scholar 

  • Dormont, J., Crosnier, J., de Montera, H., Hamburger, J.: Lésions histologiques tardives des reins homotransplantes dans le cas de tolérance prolongée. Proc. Europ. Dialysis Transpl. Ass.2, 200 (1965).

    Google Scholar 

  • Dubost, C., Cachera, J. P.: Un cas de greffe allogenique du coeur chez l'homme. Presse méd.76, 1651 (1968).

    Google Scholar 

  • Ellis, R. J., Lillehei, C. W., Zabriskie, J. B.: Detection of circulating heart-reactive antibody in human heart transplants. J. Amer. med. Ass.211, 1505 (1970).

    Google Scholar 

  • Espinosa, E., Kushner, I., Kaplan, M. H.: Antigenic composition of heart tissue. Amer. J. Cardiol.24, 508 (1969).

    PubMed  Google Scholar 

  • Fuse, Y., Tomita, F.: Pathology of cardiac transplant. Arch. Jap. Chir.39, 3 (1970).

    Google Scholar 

  • Graham, W. H., Childs, J. W., Weymouth, R. J., Kosek, J. C., Linn, F., Lower, R. R.: The reversibility of dog cardiac allograft rejection. Surg. Forum20, 145 (1969).

    PubMed  Google Scholar 

  • Grundmann, E.: Die Immunpathologie der experimentellen Allo- und Xenotransplantation. Verh. dtsch. Ges. Path.54, 65 (1970).

    Google Scholar 

  • Hagl, S., Beck, G., Brendel, W., Land, W., Mayr, N., Mendler, K., Pielsticker, K., Sebening, F.: Xenogene Herztransplantation im nah stammesverwandten Speciessystem Fuchs-Hund. Dtsch. med. Wschr.96, 216 (1971).

    PubMed  Google Scholar 

  • Haller, J. D., Cerruti, M. M.: Heart transplantation in man: Compilation of cases. Amer. J. Cardiol.24, 554 (1969).

    PubMed  Google Scholar 

  • Hamburger, J.: A reapraisal of the concept of organ rejection based on the study of homotransplanted kidneys. Transplantation5, 870 (1967).

    PubMed  Google Scholar 

  • —— Dormont, J.: Functional and morphologie alterations in longterm kidney transplants. In: Human transplantation. Rapaport and Dausset, eds. New York: Crune & Stratton 1968.

    Google Scholar 

  • Hardy, J. D., Chavez, C. M.: The first heart transplant in man: Historical re-examination of the 1964 case in the light of current clinical experience. Transpl. Proc.1, 717 (1969).

    Google Scholar 

  • —— —— Kurrus, F. D., Neely, W. A., Eraslan, S., Turner, M. D., Fabian, L. W., Labecki, T. D.: Heart transplantation in man: developmental studies and report of a case. J. Amer. med. Ass.188, 1132 (1964).

    Google Scholar 

  • Hattler, B. G., Ebert, P. A., Cosson, R.: A histochemical analysis of rejecting dog cardiac allografts. Surg. Forum20, 139 (1969).

    PubMed  Google Scholar 

  • Hollmann, K. H., Cachera, J. P.: Untersuchungen an transplantierten Herzen von Hunden. Verh. dtsch. Ges. Path.54, 676 (1970).

    Google Scholar 

  • Hurley, E. J., Kosek, J. C.: Atypical rejection of the canine heart. Transplant. Bull.8, 895 (1968).

    Google Scholar 

  • —— Lower, R. R., Shumway, N. E.: Stokes-Adams attacks in transplanted hearts. Surg. Forum16, 218 (1965).

    PubMed  Google Scholar 

  • Kahn, D. R., Carr, E. A., Oberman, H. A., Kirsch, M. M., Dufek, J. H., Moores, W. Y., Carroll, M., Gago, O., Sloan, H.: Effect of anticoagulants on the transplanted heart. J. thorac. cardiovasc. Surg.60, 616 (1970).

    PubMed  Google Scholar 

  • Kantrowitz, A.: Orthotopic cardiac allotransplantation in puppies follow-up of 38-and 21 month survivors. Trans. Amer. Soc. artif. intern. Org.16, 425 (1970).

    Google Scholar 

  • —— Haller, J. D., Joos, H., Cerruti, M. M., Carstensen, H. E.: Transplantation of the heart in an infant and an adult. Amer. J. Cardiol.22, 782 (1968)

    PubMed  Google Scholar 

  • Kaplan, M. H., Frengley, J. D.: Autoimmunity to the heart in cardiac disease. Amer. J. Cardiol.24, 459 (1969).

    PubMed  Google Scholar 

  • Kessler, E.: Pathological and ultrastructural findings in a case of heart transplantation. Israel J. med. Sci.5, 1235 (1969).

    PubMed  Google Scholar 

  • Kincaid-Smith, P.: Vascular changes in homotransplants. Brit. med. J.1964 I, 178.

    Google Scholar 

  • Knieriem, H.-J.: Morphologische Befunde bei Herztransplantation. Jahrb. Univ. Düsseldorf 1970.

  • — Piasecki, I.: Über die Wirkung von Decortin auf den Herzmuskel von Ratten (unveröffentlicht).

  • Kondo, Y., Gradel, F., Kantrowitz, A.: Heart transplantation in puppies. Long survival without immuno-suppressive therapy. Ann. Surg.162, 837 (1965).

    Google Scholar 

  • Kosek, J. C., Chartrand, C., Hurley, E. J., Lower, R. R.: Arteries in canine cardiac homografts. Ultrastructure during acute rejection. Lab. Invest.21, 328 (1969).

    PubMed  Google Scholar 

  • —— Hurley, E. J., Lower, R. R.: Histopathology of orthotopic canine cardiac homografts. Lab. Invest.19, 97 (1968).

    PubMed  Google Scholar 

  • —— —— Sewell, D. H., Lower, R. R.: Histopathology of orthotopic canine cardiac homografts and its clinical correlation. Transplantation Proc.1, 311 (1969).

    Google Scholar 

  • Largiader, F.: Organ transplantation, 2. ed. Stuttgart: Thieme 1970.

    Google Scholar 

  • —— Senning, A., Träbert, E., Rosenmund, H.: Erfassung der Abstoßung von Herztransplantaten. Helv. chir. Acta36, 289 (1969).

    PubMed  Google Scholar 

  • Leandri, J.: Some histological features of canine cardiac transplants. Thorax22, 397 (1967).

    PubMed  Google Scholar 

  • —— Cachera, J. P., Lacombe, M., Bui-Mong-Hung, Vigano, M., Horada, S.: Etude histologique des transplants cardiaque orthotopiques chez le chien. Path. et Biol.15, 501 (1967).

    Google Scholar 

  • —— Crepin, Y., Bui-Mong-Hung, Lacombe, M., Cachera, J. P.: Histologie des transplants cardiaques expérimentaux Influence des traitements immunodépresseurs. Ann. Anat. path. (Paris)14, 129 (1969).

    Google Scholar 

  • Levinsky, L., Kessler, E., Lurie, M., Ben-Bassat, M., Levy, M. J.: Ultrastructural and histopathologic observations of a human cardiac transplant with features of rejection. Amer. J. clin. Path.53, 811 (1970).

    Google Scholar 

  • Levitsky, S., Parks, L. C., Williams, W. H., Morrow, A. G.: Effects of azathioprine on ventricular hypertrophy. Circulation40, Suppl. III, 132 (1969).

    Google Scholar 

  • Lower, R. R.: Cardiac transplantation without complete cardiac denervation. The role of the afferent receptors. Amer. Heart J.72, 841 (1966).

    PubMed  Google Scholar 

  • —— Cardiovascular transplantation. Present and future. In: Human transplantation, Rapaport and Dausset, eds. New York: Grune & Stratton 1968.

    Google Scholar 

  • —— Cleveland, R. J.: The current status of heart transplantation. Advanc. Transplant.1, 657 (1967).

    Google Scholar 

  • —— Dong, E., Shumway, E. N.: Long-term survival of cardiac homografts. Surgery58, 110 (1965).

    PubMed  Google Scholar 

  • —— —— —— Suppression of rejection crisis in the cardiac homograft. Ann. thorac. Surg.1, 645 (1965).

    Google Scholar 

  • —— Kosek, J. C., Kemp, E., Graham, W. H., Sewell, D. H., Lin, F.: Rejection of the cardiac transplant. Amer. J. Cardiol.24, 492 (1969).

    PubMed  Google Scholar 

  • —— Shumway, E. N.: Studies on orthotopic homotransplantation of the canine heart. Surg. Forum11, 18 (1960).

    PubMed  Google Scholar 

  • Mann, F. C., Priestley, J. T., Markowitz, J., Yater, W. M.: Transplantation of the intact mammalian heart. Arch. Surg.26, 219 (1933).

    Google Scholar 

  • Marcus, E., Wong, S. N. T., Luisada, A. A.: Homologous heart grafts: transplantation of the heart in dogs. Surg. Forum2, 212 (1951).

    Google Scholar 

  • —— —— —— Transplantation of the heart in dogs. Arch. Surg.66, 179 (1953).

    Google Scholar 

  • Meisner, H., Gams, E., Hagl, S., Ring, J., Schmidt-Habelmann, P., Sebening, F., Struck, E.: Experimentelle Erfahrungen mit der Herztransplantation. Langenbecks Arch. klin. Chir.322, 668 (1968).

    Google Scholar 

  • Milam, J. D., Shipkey, F. H., Lind, C. J., Nora, J. J., Leachman, R. D., Rochelle, D. G., Bloodwell, R. D., Hallman, G. L., Cooley, D. A.: Morphologic findings in human cardiac allografts. Circulation41, 519 (1970).

    PubMed  Google Scholar 

  • Müller-Ruchholtz, W.: Grundlagen der Transplantations-immunologie. Dtsch. med. Wschr.96, 347 (1971).

    PubMed  Google Scholar 

  • Myburgh, J. A., Cohen, I., Gecelter, L., Meyers, A. M., Abrahams, C., Furman, K. I., Goldberg, B., Blerk, P. J. P. van: Hyperacute rejection in human kidney allografts. Shwartzman or Arthus reaction? New Engl. J. Med.281, 131 (1969).

    PubMed  Google Scholar 

  • Napolitano, L., Cooper, T., Willman, V. L., Hanlon, C. R.: Fine structure of heart after transplantation: with special reference to neural elements. Circulation29, Suppl. I, 81 (1964).

    PubMed  Google Scholar 

  • Neville, W. E., Balis, J. U., Pifarré, Cox, W. D., Dwan, F., Lynch, R. D., Rappaport, E. S.: The microcirculation of the transplanted heart. J. thorac. cardiovasc. Surg.58, 625 (1969).

    PubMed  Google Scholar 

  • Nienhaus, H., Poche, R., Reimold, E.: Elektrolytverschiebungen, histologische Veränderungen der Organe und Ultrastruktur des Herzmuskels nach Belastung mit Cortisol, Aldosteron und primärem Natriumphosphat bei der Ratte. Virchows Arch. path. Anat.337, 245 (1963).

    Google Scholar 

  • Nora, J. J., Cooley, D. A., Fernbach, D. J., Rochelle, D. G., Milam, J. D., Montgomery, J. R., Leachman, R. D.: Rejection of the transplanted human heart. Indexes of recognition and problems in prevention. New Engl. J. Med.280, 1079 (1969).

    PubMed  Google Scholar 

  • Oliver, C. B., DeWitt, C. W., Creech, O.: Histochemical studies of early rejection in allogenic rat hearts. Surg. Forum16, 215 (1965).

    PubMed  Google Scholar 

  • Ono, K., Lindsey, E. S., Creech, O.: Transplanted rat heart: local graft irradiation. Transplantation7, 176 (1969).

    PubMed  Google Scholar 

  • Palfry, A. J.: The fine structure of the mitral valve in allotransplanted hearts. J. Anat. (Lond.)104, 179 (1969).

    Google Scholar 

  • Philips, S. J., Reid, J. A., Rugh, R.: Electrocardiographic and pathologic changes after cardiac irradiation in dogs. Amer. Heart J.68, 524 (1964).

    PubMed  Google Scholar 

  • Pichlmayr, R.: Immunsuppression und Organtransplantation. Münch. med. Wschr.109, 2277 (1967).

    Google Scholar 

  • Pierce, J.: Diskussionsbemerkungen. In: Experience with human heart transplantation, p. 190, H. A. Shapiro, ed. Durban: Butterworths 1969.

    Google Scholar 

  • Porter, K. A., Calne, R. Y., Zuboski, C. E.: Vascular and other changes in 200 canine renal homografts treated with immunosuppressive drugs. Lab. Invest.13, 809 (1964).

    Google Scholar 

  • Ralston, M.: A heart transplantation: VI. Pathological aspects. Med. J. Aust.56, I, 676 (1969).

    Google Scholar 

  • Rapaport, G. T., Dausset, J.: Human transplantation. New York: Grune & Stratton 1968.

    Google Scholar 

  • Reemtsma, K.: The heart as a test organ in transplantation studies. Ann. N.Y. Acad. Sci.120, 778 (1964).

    PubMed  Google Scholar 

  • Rowlands, D. T., Vanderbeek, R. B., Seigler, H. F., Ebert, P. A.: Rejection of canine cardiac allografts. Amer. J. Path.53, 617 (1968).

    PubMed  Google Scholar 

  • Saunders, A. M., Bieber, C.: Pathologic findings in a case of cardiac transplantation. J. Amer. med. Ass.206, 815 (1968).

    Google Scholar 

  • Sebening, F., Gams, F., Klinner, W., Meisner, H., Schmidt-Habelmann, P., Struck, E.: Zur Transplantation des Herzens. Langenbecks Arch. Chir.325, 731 (1969).

    PubMed  Google Scholar 

  • —— Klinner, W., Meisner, H., Schmidt-Habelmann, P., Struck, E., Spelsberg, F., Lucas, M., Dragojevic, B., Nitschke, J., Beer, R., Soga, D., Manz, R., Boldt, U., Dietrich, H. P., Soldhdju, H., Charlet, D., Rudolph, W., Dietze, G., Baubkus, H., Müller-Seydlitz, P., Zeitlmann, F., Pickardt, R., Mesmer, K., Land, W., Kugler, J., Beck, O. J., Schauer, A., Konopka, P.: Bericht über die Transplantation eines menschlichen Herzens. Dtsch. med. Wschr.94, 883 (1969).

    PubMed  Google Scholar 

  • Selye, H.: The chemical prevention of cardiac necroses. New York: Ronald Press 1958.

    Google Scholar 

  • —— Experimental cardiovascular diseases. Berlin-Heidelberg-New York: Springer 1970.

    Google Scholar 

  • Shapiro, H. A., ed.: Experience with human heart transplantation. Durban: Butterworths 1969.

    Google Scholar 

  • Sinizyn, N. P.: Herztransplantation. Berlin: Volk und Gesundheit 1957. [Russisch.] Moskau 1948.

  • Starzl, T. E., Lerner, B. A., Dixon, F. J., Groth, C. G., Brettschneider, L., Terasaki, P. I.: Shwartzman reaction after human renal homotransplantation. New Engl. J. Med.278, 642 (1968).

    PubMed  Google Scholar 

  • Stinson, E. B., Dong, E., Bieber, C. P., Popp, R. L., Shumway, N. E.: Cardiac transplantation in man. II. Immunosuppressive therapy. J. thorac. cardiovasc. Surg.58, 326 (1969).

    PubMed  Google Scholar 

  • —— —— —— Schroeder, J. S., Shumway, N. E.: Cardiac transplantation in man. I. Early rejection. J. Amer. med. Ass.207, 2233 (1969).

    Google Scholar 

  • —— —— Schroeder, J. S., Harrison, D. C., Shumway, N. E.: Initial clinical experience with heart transplantation. Amer. J. Cardiol.22, 791 (1968).

    PubMed  Google Scholar 

  • —— Griepp, R. B., Clark, D. A., Dong, E., Shumway, N. E.: Cardiac transplantation in man. VIII. Survival and function. J. thorac. cardiovasc. Surg.60, 303 (1970).

    PubMed  Google Scholar 

  • Symbas, P. N., Schlant, R. C., Gravanis, M. B.: Total interruption of the cardiac lymphatics: functional and pathologic effects. Surg. Forum19, 169 (1968).

    PubMed  Google Scholar 

  • Thomson, J. G.: Heart transplantation in man — necropsy findings. Brit. med. J.1968 II, 511.

    Google Scholar 

  • —— Transplantation of the heart: The pathological features of rejection. Int. Congr. Int. Acad. Path. Milan, 1968. Rome: Acc. Naz. Lincei 1970.

    Google Scholar 

  • —— Production of severe atheroma in a transplanted human heart. Lancet1969 II, 1088.

    Google Scholar 

  • Thomson, J. G.: Diskussionsbemerkung zum Vortrag H. W. Weber. Verh. dtsch. Ges. Path.54, 124 (1970).

    Google Scholar 

  • Übermuth, H.: Über Organtransplantationen. Bericht über Herz-und Kopfverpflanzungen durch W. Demichov, Moskau. Münch. med. Wschr.101, 529 (1959).

    Google Scholar 

  • Wandall, H. H.: A review of cardiac transplantation in man. Scand. J. thorac. cardiovasc. Surg.4, 5 (1970).

    PubMed  Google Scholar 

  • Webb, W. R.: Diskussionsbemerkung. Ann. Surg.169, 904 (1969).

    Google Scholar 

  • Weber, H. W.: Pathologische Befunde bei Organtransplantationen beim Menschen. Verh. dtsch. Ges. Path.54, 94 (1970).

    Google Scholar 

  • Wenger, F.: Tödliche Blutung nach Herztransplantation beim Hund. Verh. dtsch. Ges. Path.54, 181 (1970).

    Google Scholar 

  • Willman, V. L., Hanlon, C. R.: Heart transplantation in primates. Ann. N.Y. Acad. Sci.162, 156 (1969).

    PubMed  Google Scholar 

  • Zenker, R., Klinner, W., Sebening, F., Meisner, H., Schmidt-Habelmann, P., Struck, E., Beer, R., Messmer, K., Rudolph, W., Schauer, A.: Herztransplantation. Möglichkeiten und Problematik. Münch. med. Wschr.111, 749 (1969).

    Google Scholar 

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  1. Pathologisches Institut und Chirurgische Klinik der Universität Düsseldorf, Germany

    H. -J. Knieriem, H. Meessen & H. D. Schulte

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  1. H. -J. Knieriem
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  2. H. Meessen
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  3. H. D. Schulte
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Mit Unterstützung des Sonderforschungsbereiehes Kardiologie der Deutschen Forschungsgemeinschaft.

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Knieriem, H.J., Meessen, H. & Schulte, H.D. Morphologische Befunde bei Herztransplantationen. Klin Wochenschr 49, 837–852 (1971). https://doi.org/10.1007/BF01513466

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  • DOI: https://doi.org/10.1007/BF01513466

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