Skip to main content
SpringerLink
Log in

Pathology of Cardiac Allograft Vascular (Microvascular) Rejection: Impact on Patient Outcomes

  • Chapter
Cardiac Allograft Rejection

  • 72 Accesses

Abstract

Pathologic descriptions of allograft rejection of solid organs have long recognized several forms of vascular involvement as part of the rejection process. Renal allografts commonly display vasculitis involving the arteries and arterioles of the cortex with or without cellular infiltrates invading tubules in the severest forms of acute rejection.1–3 This vascular inflammatory process, often termed acute vascular rejection, is identified in 50% of acutely rejecting kidneys and is frequently associated with allograft injury or loss in spite of increased immunosuppressive therapy.2–4 By contrast, arteritis is rarely identified in cardiac allografts on endomyocardial biopsy although it has been associated with poor allograft survival.5,6

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Jeannet M, Pinn V, Flax M, Winn HJ, Russell PS. Humoral Antibodies in renal allotransplantation in man. N Engl J Med 1970; 282:111–117.

    Article  PubMed  CAS  Google Scholar 

  2. Farnsworth A, Hall BM, Ng ABP, et al. Renal biopsy morphology in renal transplantation. Am J Surg Pathol 1984; 8:243–252.

    Article  PubMed  CAS  Google Scholar 

  3. Salmela KT, von Willebrand EO, Kyllonen LEJ, Acute vascular rejection in renal transplantation-diagnosis and outcome. Transplantation 1992; 54:858–862.

    Article  PubMed  CAS  Google Scholar 

  4. Colvin, Robert B. Kidney Transplantation. In: Diagnostic Immunopathology. RB Colvin, AT Bhan and RT McCluskey (editors). NY: Raven Press 1995; 329–366.

    Google Scholar 

  5. Herskowitz A, Soule LM, Ueda K, Tamura F, Baumgartner WA, Borton AM, Reitz BA, Achuff SC, Traill TA, Baughman KL. Arteriolar vasculitis on endomyocardial biopsy: a histologic predictor of poor outcome and cyclosporine-treated heart transplant recipients. J Heart Transplant 1987; 6: 127–136.

    PubMed  CAS  Google Scholar 

  6. Smith SH, Kirklin JK, Geer JC, Caulfield JB, McGiffin DC. Arteritis and cardiac rejection after transplantation. Am J Cardiology 1987; 59:1171–1173.

    Article  CAS  Google Scholar 

  7. Forbes RDC, Guttman RD, Gomersall M, Hibberd J. A controlled serial ultrastructural tracer study of first set cardiac allograft rejection in the rat. Am J Pathol 1983; 111:184–196.

    PubMed  CAS  Google Scholar 

  8. Leszcynski D, Laszcyska M, Halttunen J, Hayry P. Renal target structures in acute allograft rejection: a histochemical study. Kidney Int 1987; 31:1311–1316.

    Article  Google Scholar 

  9. Dvorak HF, Mihm MC, Dvorak AM, et al. Rejection of first set skin allografts in man: the microvas-culature is the critical target of the immune response. J Exp Med 1979; 150:322–337.

    Article  PubMed  CAS  Google Scholar 

  10. Butcher EC. The regulation of lymphocyte traffic. Curr Top Microbiol Immunol. 1986; 128: 85–122.

    Article  PubMed  CAS  Google Scholar 

  11. Berg EL, Goldstein LA, Jutila MA, et al. Homing receptors and vascular addressins: cell adhesion molecules that direct lymphocyte migration. Immunol Rev 1989; 108:5–18.

    Article  PubMed  CAS  Google Scholar 

  12. Hammond EH. Cardiac transplantation. In: Diagnostic Immunopathology RB Colvin, A Bhan and R McCluskey, editors NY: Raven Press 1995, p. 367.

    Google Scholar 

  13. Demetris AJ, Lasky S, Van Thiel DH, et al. Pathology of hepatic transplantation: A review of 62 adult allograft recipients immunosuppressed with a cyclosporine/steroid regimen. Am J Pathol 1985; 118:151–161.

    PubMed  CAS  Google Scholar 

  14. Stewart S. Pathology of lung transplantation. Seminars in Diagnostic Pathology 1992; 9:210–217.

    PubMed  CAS  Google Scholar 

  15. Snover DC, Freese DK, Sharp HL, et al. Liver allograft rejection: an analysis of the use of biopsy in determining outcome of rejection. Am J Surg Pathol 1987; 11:1–10.

    Article  PubMed  CAS  Google Scholar 

  16. Hammond EH. Transplant Pathology. In: Principles and Practice of Surgical Pathology and Cytopathology, Third Edition. SG Silverberg, RA DeLellis, WJ Frable, editors. NY: Churchill Livingstone 1997, p. 253.

    Google Scholar 

  17. Billingham ME, Cary NRB, Hammond ME, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: heart rejection study group. J Heart Transplant 1990; 9:587–592.

    PubMed  CAS  Google Scholar 

  18. Waldenstrom A, Martinussen HJ, Gerdin B, Hallgren R. Accumulation of hyaluronan and tissue edema in experimental myocardial infarction. J Clin Invest 1991; 88(5): 1622–1628.

    Article  PubMed  CAS  Google Scholar 

  19. Hallgren R, Gerdin B, Tengblad A, Tufveson G. Accumulation of hyaluronan (hyaluronic acid) in myocardial interstitial tissue parallels development of transplantation edema in heart allografts in rats. J Clin Invest 1990; 85(3):668–673.

    Article  PubMed  CAS  Google Scholar 

  20. Demetris AJ, Murase N, Ye Q, Galvao FH, Richert C, Saad R, Pham S, Duquesnoy RJ, Zeevi A, Fung JJ, Starzl TE. Analysis of chronic rejection and obliterative arteriopathy. Possible contributions of donor antigen-presenting cells and lymphatic disruption. Am J Pathol 1997; 150(2): 563–578.

    PubMed  CAS  Google Scholar 

  21. Watschinger B, Sayegh MH. Endothelin in organ transplantation. Am J Kidney Dis 1996; 27(1): 151–161.

    Article  PubMed  CAS  Google Scholar 

  22. Prop J, Kuijpers K, Petersen AH, Bartels HL, Nieuwenhuis P, Wildevuur CR. Why are lung allografts more vigorously rejected than hearts? J Heart Transplant 1985; 4(4):433–36.

    PubMed  CAS  Google Scholar 

  23. Hammond EH, Yowell RL, Nunoda S, et al. Vascular (humoral) rejection in heart transplantation: pathologic observations and clinical implications. J Heart Transplant 1989; 8:430–443.

    PubMed  CAS  Google Scholar 

  24. Hammond EH, Yowell RL, Price GD, et al. Vascular rejection and its relationship to allograft coronary artery disease. J Heart Transplant 1992; 11: 111–119.

    Google Scholar 

  25. Hammond EH, Hansen J, Spencer LS, et al. Vascular rejection in cardiac transplantation: Histologic, immunopathologic, and ultrastructural features. Cardiovasc Pathol 1993; 2:21–34.

    Article  Google Scholar 

  26. Woodley SL, Renlund DG, O’Connell JB, Bristow MR. Immunosuppression following cardiac transplantation. J Heart Transplant, Cardiology Clinics 1990; 8:83–87.

    PubMed  CAS  Google Scholar 

  27. Renlund DG, O’Connell JB, Gilbert EM. A prospective comparison of murine monoclonal CD-3 (OKT3) antibody-based and equine antithymocyte globulin-based rejection prophylaxis in cardiac transplantation. Transplantation 1989; 47:599–605.

    Article  PubMed  CAS  Google Scholar 

  28. Ensley RD, Hammond EH, Renlund DG, et al. Clinical manifestations of vascular rejection in cardiac transplantation. Transplant Proc 1991; 23:1130–1132.

    PubMed  CAS  Google Scholar 

  29. Ma H, Hammond EH, Taylor DO, Yowell RL, Bristow MR, O’Connell JB, Renlund DG. The repetitive histologic pattern of vascular cardiac allograft rejection. Increased incidence associated with longer exposure to prophylactic murine monoclonal anti-CD3 antibody (OKT3). Transplantation 1996; 62(2):205–210.

    Article  PubMed  CAS  Google Scholar 

  30. Hammond EH, Hansen LK, Spencer LS, et al. Immunofluorescence of endomyocardial biopsy speciments: methods and interpretation. J Heart Lung Transplant 1993;12:S113–S124.

    PubMed  Google Scholar 

  31. Loy TS, Bulatao IS, Darkow GV, Demmy TL, Reddy HK, Curtis J, Bickel JT. Immunostaining of cardiac biopsy specimens in the diagnosis of acute vascular (humoral) rejection: a control study. J Heart Lung Transplant 1993 Sep; 12(5):736–740.

    PubMed  CAS  Google Scholar 

  32. Labarrere CA, Pitts D, Nelson DR, Faulk WP. Vascular tissue plasminogen activator and the development of coronary artery disease in heart-transplant recipients. N Engl J Med 1995; 333(17): 1111–1116.

    Article  PubMed  CAS  Google Scholar 

  33. Labarrere CA, Pitts D, Halbrook H, Faulk WP. Tissue plasminogen activator, plasminogen activator inhibitor-1, and fibrin as indexes of clinical course in cardiac allograft recipients: An immuno-cytochemical study. Circulation 1994;89:1599–1608.

    Article  PubMed  Google Scholar 

  34. Lones MA, Czer LS, Trento A, Harasty D, Miller JM, Fishbein MC. Clinical-pathologic features of humoral rejection in cardiac allografts: a study in 81 consecutive patients. J Heart Lung Transplant 1995; 14(1 Pt 1):151–162.

    PubMed  CAS  Google Scholar 

  35. Hook S, Caple JF, McMahon JT, Myles JL, Ratliff NB. Comparison of myocardial cell injury in acute cellular rejection versus acute vascular rejection in cyclosporine-treated heart transplants. J Heart Lung Transplant 1995; 14(2):351–358.

    PubMed  CAS  Google Scholar 

  36. Ratliff NB, McMahon JT. Activation of intravascular macrophages within myocardial small vessels is a feature of acute vascular rejection in human heart transplants. J Heart Lung Transplant 1995; 14(2):338–345.

    PubMed  CAS  Google Scholar 

  37. Rand JH, Wu XX, Potter BJ, et al. Co-localization of von Willebrand factor and type VI collagen in human vascular subendothelium. Am J Pathol 1993; 142:843–850.

    PubMed  CAS  Google Scholar 

  38. Suster S, Wong TY. On the discriminatory value of anti-HPCA-1 (CD-34) in the differential diagnosis of benign and malignant cutaneous vascular proliferations. Am J Dermatopathol 1994; 16:355–363.

    Article  PubMed  CAS  Google Scholar 

  39. Tipping PG, Davenport P, Gallicchio M, et al. Atheromatous plaque macrophages produce plasminogen activator inhibitor type-1 and stimulate its production by endothelial cells and vascular smooth muscle cells. Am J Pathol 1993; 143:875–885.

    PubMed  CAS  Google Scholar 

  40. Sell KW, Talaat T, Wang YC, et al. Studies of major histocompatibility complex class I/II expression on sequential human heart biopsy specimens after transplantion. J Heart Transplant 1988; 7:407–18.

    PubMed  CAS  Google Scholar 

  41. Marboe CC, Schierman SW, Rose E, et al. Characterization of mononuclear cell infiltrates in human cardiac allografts. Transplant Proc 1984; 16:1598–1599.

    PubMed  CAS  Google Scholar 

  42. Colvin RB. Diagnostic use in transplantation, clinical applications of monoclonal antibodies in renal allograft biopsies. Am J Kidney Dis 1988;11:2,126–130.

    PubMed  CAS  Google Scholar 

  43. Hengstenberg C, Rose ML, Page C, Taylor PM, Yacoub MH. Immunocytochemical changes suggestive of damage to endothelial cells during rejection of human cardiac allografts. Transplantation 1990; 49(5):895–899.

    Article  PubMed  CAS  Google Scholar 

  44. Gassel AM, Hansmann ML, Radzun HJ, Weyland M. Human cardiac allograft rejection. Correlation of grading with expression of different monocyte/macrophage markers. Am J Clin Pathol 1990; 94:274–279.

    PubMed  CAS  Google Scholar 

  45. Paul LC, Grothman GT, Benediktsson H, Davidoff A, Rozing J. Macrophage subpopulations in normal and transplanted heart and kidney tissues in the rat. Transplantation 1992; 53(1): 157–162.

    Article  PubMed  CAS  Google Scholar 

  46. Szabolcs M, Michler RE, Yang X, Aji W, Roy D, Athan E, Sciacca RR, Minanov OP, Cannon PJ. Apoptosis of cardiac myocytes during cardiac allograft rejection. Relation to induction of nitric oxide synthase. Circulation 1996; 94(7): 1665–1673.

    Article  PubMed  CAS  Google Scholar 

  47. Jollow KC, Sundstrom JB, Gravanis MB, Kanter K, Herskowitz A, Ansari AA. Apoptosis of mononuclear cell infiltrates in cardiac allograft biopsy specimens questions studies of biopsy-cultured cells. Transplantation 1997; 63(10): 1482–1489.

    Article  PubMed  CAS  Google Scholar 

  48. Briscoe DM, Yeung AC, Schoen EL, Allred EN, Stavrakis G, Ganz P, Cotran RS, Pober JS. Predictive value of inducible endothelial cell adhesion molecule expression for acute rejection of human cardiac allografts. Transplantation 1995; 59:204–211.

    PubMed  CAS  Google Scholar 

  49. Lemstrom K, Koskinen P, Hayry P. Induction of adhesion molecules on the endothelia of rejecting cardiac allografts. J Heart Lung Transplant 1995; 14:205–213.

    PubMed  CAS  Google Scholar 

  50. Hosenpud JD, Shipley GD, Morris TE, et al. The modulation of human aortic endothelial cell ICAM-1 expression by serum containing high titers of anti-HLA antibodies. Transplantation 1993; 55:405–111.

    PubMed  CAS  Google Scholar 

  51. Deng MC, Bell S, Huie P. Cardiac allograft vascular disease: relationship to microvascular cell surface markers and inflammatory cell phenotype on endomyocardial biopsy. Circulation 1995; 91:1647–1654.

    Article  PubMed  CAS  Google Scholar 

  52. Boiling SF, Kunkel SL, Lin H. Prolongation of cardiac allograft survival in rats by anti-TNF and cyclosporine combination therapy. Transplantation 1992; 53:283–286.

    Article  Google Scholar 

  53. Imagawa DK, Millis JM, Seu P, Olthoff KM, Hart J, Wasef E, Dempsey RA, Stephens S, Busuttil RW. The role of tumor necrosis factor in allograft rejection. III. Evidence that anti-TNF antibody therapy prolongs allograft survival in rats with acute rejection. Transplantation 1991 Jan; 51 (l):57–62.

    Article  PubMed  CAS  Google Scholar 

  54. Sadahiro M, McDonald TO, Allen MD. Reduction in cellular and vascular rejection by blocking leukocyte adhesion molecule receptors. Am J Pathol 1993; 142:675–683.

    PubMed  CAS  Google Scholar 

  55. Forbes RD, Cernacek P, Zheng S, Gomersall M, Guttmann RD. Increased endothelin expression in a rat cardiac allograft model of chronic vascular rejection. Transplantation 1996; 61(5):791–797.

    Article  PubMed  CAS  Google Scholar 

  56. Yokoi Y, Nakamura S, Serizawa A, Nishiyama R, Nishiwaki Y, Baba S. The role of endothelin in the pathophysiology of renal impairment during acute liver rejection. Transplantation 1994; 58(2): 144–149.

    PubMed  CAS  Google Scholar 

  57. Watschinger B, Sayegh MH. Endothelin in organ transplantation. Am J Kidney Dis 1996; 27(1):151–161.

    Article  PubMed  CAS  Google Scholar 

  58. Jordan SC, Czer L, Toyoda M. Serum cytolkine levels in heart allograft recipients: correlation with findings on endomyocardial biopsy. J Heart Lung Tranplant 1993; 12:333–337.

    CAS  Google Scholar 

  59. Morgan CJ, Pelletier RP, Hernadez CJ, et al. Alloantigen dependent endothelial phenotype and lymphokine mRNA expression in rejectiong murine cardiac allografts. Transplantation 1993; 55:919–924.

    Article  PubMed  CAS  Google Scholar 

  60. Russell ME, Wallace AF, Hancock WW, Sayegh MH, Adams DH, Sibinga NE, Wyner LR, Karnovsky MJ. Upregulation of cytokines associated with macrophage activation in the Lewis-to-F344 rat transplantation model of chronic cardiac rejection. Transplantation 1995; 59(4):572–578

    PubMed  CAS  Google Scholar 

  61. Alpers CE, Davis CL, Barr D, Marsh CL, Hudkins KL. Identification of platelet-derived growth factor A and B chains in human renal vascular rejection. Am J Pathol 1996; 148(2):439–451

    PubMed  CAS  Google Scholar 

  62. Leventhal JR, Sakiyalak P, Witson J, Simone P, Matas AJ, Bolman RM, Dalmasso AR The syner-gistic effect of combined antibody and complement depletion on discordant cardiac xenograft survival in nonhuman primates. Transplantation 1993; 57:974–977.

    Google Scholar 

  63. Kobayashi T, Taniguchi S, Ye Y, Niekrasz M, Kosanke S, Neethling FA, Wright LJ, Rose AG, White DJ, Cooper DK. Delayed xenograft rejection in C3-depleted discordant (pig-to-baboon) cardiac xenografts treated with cobra venom factor. Transplant Proc 1996; 28(2):560–560

    PubMed  CAS  Google Scholar 

  64. Leventhal JR, Matas AJ, Sun LH, Reif S, Bolman RM III, Dalmasso AP, Piatt JL. The immunopathology of cardiac xenograft rejection in the guinea pig-to-rat model. Transplantation 1993; 56:1–8.

    Article  PubMed  CAS  Google Scholar 

  65. Breisblatt WM, Schulman DS, Stein K, et al. Hemodynamic response to OKT3 in 6 orthotopic heart transplant recipients: Evidence of reversible myocardial dysfunction. J Heart Lung Transplant 1991; 10: 359–365.

    PubMed  CAS  Google Scholar 

  66. Abramowicz D, Schandene L, Goldman M, et al. Release of tumor necrosis factor, interleukin-2, and gamma-interferon in serum after injection of OKT3 monoclonal antibody in kidney transplant recipients. Transplantation 1989; 47:606–608.

    Article  PubMed  CAS  Google Scholar 

  67. Pober JS, Doukas J, Hughes CC, Savage CO, Munro JM, Cotran RS. The potential roles of vascular endothelium in immune reactions. Hum Immunol 1990; 28(2):258–262

    Article  PubMed  CAS  Google Scholar 

  68. Cotran RS, Pober JS, Gimbrone MA, Springer TA, Wiebke EA, Gaspari AA, Rosenberg SA, Lotze MT. Endothelial activation during interleukin 2 immunotherapy: a possible mechanism for the vascular leak syndrome. J Immunol 1987; 139:1883–1888.

    Google Scholar 

  69. Toyoda M, Galfayan K, Galera OA, Petrosian A, Czer LS, Jordan SC. Cytomegalovirus infection induces anti-endothelial cell antibodies in cardiac and renal allograft recipients. Transpl Immunol 1997; 5(2): 104–111.

    Article  PubMed  CAS  Google Scholar 

  70. Gaudin PB, Rayburn BK, Hutchins GM. Peritransplant injury to the myocardium associated with the development of accelerated arteriosclerosis in heart transplant recipients. Am J Surg Pathol 1994; 18:338–346.

    Article  PubMed  CAS  Google Scholar 

  71. Carlquist JF, Hammond EH, Yowell RL, et al. Correlation between class II antigen (DR) expression and interleukin 2 induced lymphocyte proliferation during acute cardiac allograft rejection. Tran-plantation 1990; 50:582–588.

    CAS  Google Scholar 

  72. Miller LW, Wesp A, Jennison SH, et al. Vascular rejection in heart transplant recipients. J Heart Lung Transplant 1993; 12:S147–152.

    PubMed  CAS  Google Scholar 

  73. Costanzo-Nordin MR, Heroux AL, Radvany R, Koch D, Robinson JA. Role of humoral immunity in acute cardiac allograft dysfunction. J Heart Lung Transplant 1993 Mar; 12(2): S143–S146

    PubMed  CAS  Google Scholar 

  74. Hammond EH, Yowell RL. Pathologic evaluation of early cardiac allograft dysfunction. Pathology Case Reviews 1998; 3:1–7.

    Article  Google Scholar 

  75. Neish AS, Loh E, Schoen FJ. Myocardial changes in cardiac transplant-associated coronary arteriosclerosis: Potential for Timely Diagnosis. J Am Coll Cardiol 1992; 19:586–592

    Article  PubMed  CAS  Google Scholar 

  76. Winters GL, Schoen FJ. Graft arteriosclerosis-induced myocardial pathology in heart transplant recipients: predictive value of endomyocardial biopsy. J Heart Lung Transplant 1997 Oct; 16(10):985–993.

    PubMed  CAS  Google Scholar 

  77. Zehr KJ, Herskowitz A, Lee PC, et al. Neutrophil adhesion inhibition prolongs survival of cardiac allografts with hyperacute rejection. J Heart Lung Tranplant 1993; 12:837–844

    CAS  Google Scholar 

  78. Trento A, Hardesty RL, Griffith BP, et al. Role of the antibody to vascular endothelial cells in hyperacute rejection in patients undergoing cardiac transplantation. J Thorac Cardiovasc Surg 1988; 95:37–41.

    PubMed  CAS  Google Scholar 

  79. Rose AG, Cooper DK. A histopathologic grading system of hyperacute (humoral, antibody-mediated) cardiac xenograft and allograft rejection. J Heart Lung Transplant 1996; 15(8):804–817

    PubMed  CAS  Google Scholar 

  80. Loy TS, Demmy T. Interobserver variability in the diagnosis of cardiac rejection. Modern Pathol 1995;8:29A.

    Google Scholar 

  81. Olsen SL, Wagoner LE, Hammond EH, Taylor DO, Yowell RL, Ensley RD, Bristow MR, O’Connell JB, Renlund DG. Vascular rejection in heart transplantation: clinical correlation, treatment options, and future considerations. J Heart Lung Transplant 1993;12:S135–S142

    PubMed  CAS  Google Scholar 

  82. Gill EA, Borrego C, Bray BE, Renlund DG, Hammond EH, Gilbert EM. Left ventricular mass increases during cardiac allograft vascular rejection. J Am Coll Cardiol 1995;25:922–6

    Article  PubMed  CAS  Google Scholar 

  83. Marboe CC. Cardiac Transplant Vasculopathy. in Solid Organ Transplantation Pathology, EH Hammond, editor, WB Saunders Co, Philadelphia, 1994,p.l11.

    Google Scholar 

  84. Billingham ME. Pathology and etiology of chronic rejection of the heart. Clin Transplant 1994; 8(3 Pt 2):289–292.

    PubMed  CAS  Google Scholar 

  85. Hammond EH, Yowell RL. Ultrastructural findings in cardiac transplant recipients. Ultrastructural Pathol 1994; 18:213–220.

    Article  CAS  Google Scholar 

  86. Labarrere CA, Nelson DR, Faulk WR. Endothelial activation and development of coronary artery disease in transplanted human hearts. JAMA 1997; 278(14):1169–1175.

    Article  PubMed  CAS  Google Scholar 

  87. Hammond EH. Microvascular cardiac rejection. In: Transplantation and Replacement of Thoracic Organs. DKC Cooper, LW Miller, GA Patterson, editors. Boston. Kluwer Academic Publishers, 1996, p. 239–252.

    Chapter  Google Scholar 

  88. Bielory L, Gascon P, Lawley TJ, Young NS, Frank MM. Human serum sickness: a prospective analysis of 35 patients treated with equine anti-thymocyte globulin for bone marrow failure. Medicine (Baltimore). 1988;67(l):40–57,89.

    Google Scholar 

  89. Lawley TJ, Bielory L, Gascon P. A prospective clinical and immunologic analysis of patients with serum sickness. N Engl J Med 1984;311:1407–1413.

    Article  PubMed  CAS  Google Scholar 

  90. Prin Mathieu C, Renoult E, Kennel De, March A, Bene MC, Kessler M, Faure GC. Serum anti-rabbit and anti-horse IgG, IgA, and IgM in kidney transplant recipients. Nephrol Dial Transplant. 1997;12(10):2133–2139.

    Article  PubMed  CAS  Google Scholar 

  91. Suthanthiran M, Fotino M, Riggio RR, et al. OKT3 Associated Adverse Reactions: Mechanistic basis and therapeutic options. Am J Kidney Dis 1989;14:39–44.

    PubMed  CAS  Google Scholar 

  92. Jaffers GJ, Fuller TC, Cosimi B, et al. Monoclonal antibody therapy: anti-idiotypic and non antiidiotype to OKT3 arising despite intense immunosuppression. Transplantation 1986;41:572–578.

    Article  PubMed  CAS  Google Scholar 

  93. Hammond EH, Wittwer CT, Greenwood J, et al. Relationship of OKT3 sensitization and vascular rejection in cardiac transplant patients receiving OKT3 rejection prophylaxis. Transplantation 1990; 50:776–782.

    Article  PubMed  CAS  Google Scholar 

  94. Wittwer CT, Knape WA, Bristow MR, Gilbert EM, Renlund DG, O’Connell JB, DeWitt CW. Quantitative flow cytometric plasma OKT3 assay: potential application in cardiac transplantation. Transplantation 1989;48:533–535.

    Article  PubMed  CAS  Google Scholar 

  95. Hammond E, Yowell R, Greenwood J, et al. Monitoring of patients for OKT3 sensitization prevents adverse outcome. Transplantation 1993;55:1061–1063.

    Article  PubMed  CAS  Google Scholar 

  96. Pober JS, Cotran RS. The role of endothelial cells in inflammation. Transplantation 1990;50:537–544.

    Article  PubMed  CAS  Google Scholar 

  97. Cines DB. Disorders associated with antibodies to endothelial cells. Rev Infect Dis 1989;11Suppl 4:S705–S711.

    Article  PubMed  Google Scholar 

  98. Pober JS, Orosz CG, Rose ML, Savage CO. Can graft endothelial cells initiate a host anti-graft immune response? Transplantation 1996;61(3):343–349.

    Article  PubMed  CAS  Google Scholar 

  99. Shaddy RE, Prescott SM, Mclntyre TM, Zimmerman GA. Role of Endothelial Cells in Tranplant Rejection, in Solid Organ Transplantation Pathology, EH Hammond, editor, WB Saunders Co, Philadelphia, 1994, p. 35.

    Google Scholar 

  100. Lemstrom K, Koskinen P, Hayry P. Molecular mechanisms of chronic renal allograft rejection. Kidney Int Suppl 1995;52:S2–S10.

    PubMed  CAS  Google Scholar 

  101. Miltenburg AM, et al. Induction of antibody-dependent cellular cytotoxicity against endothelial cells by renal transplantation. Transplantation 1989;48:681–684.

    Article  PubMed  CAS  Google Scholar 

  102. Caillat-Zucman S, Blumenfeld N, Legendre C, et al. The OKT3 immunosuppressive effect: in situ modulation of human graft infiltrating T cells. Transplantation 1990;49:156–160.

    Article  PubMed  CAS  Google Scholar 

  103. Chatenoud L, Ferran C, Reuter A, et al. Systemic reaction to the monoclonal antibody OKT3 in relation to serum levels of tumor necrosis factor and interferon gamma. N Engl J Med 1989;320:1420–1422.

    Article  PubMed  CAS  Google Scholar 

  104. Ferran C, Dautry F, Merite S, Sheehan K, Schreiber R, Grau G, Bach JF. Chatenoud L Anti-tumor necrosis factor modulates anti-CD3-triggered T cell cytokine gene expression in vivo. J Clin Invest 1994;93(5):2189–2196.

    Article  PubMed  CAS  Google Scholar 

  105. Pizarro TT, Malinowska K, Kovacs EJ, et al. Induction of TNFa and TNFb gene expression in rat cardiac transplants during allograft rejection. Transplantation 1993;6:399–404.

    Article  Google Scholar 

  106. Maury CPJ, Teppo AM. Raised serum levels of cachetin tumor necrosis factor a in renal allograft rejection. J Exp Med 1987;166:1132–1137.

    Article  PubMed  CAS  Google Scholar 

  107. Chollet-Martin S, Depoix JP, Hvass U, et al. Raised plasma levels of tumor necrosis factor in heart allograft rejection. Transplant Proc 1990;22:283–286.

    PubMed  CAS  Google Scholar 

  108. Dvorak HF, Galli SJ, Dvorak AM. Cellular and vascular manifestations of cell-mediated immunity. Hum Pathol 1986;17:122–137.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiac Transplant Program Utah Transplantation, Affiliated Hospital (Utah), Salt Lake City, Utah, USA

    Elizabeth H. Hammond M.D., Robert L. Yowell M.D., Ph.D & Dale G. Renlund M.D

Authors
  1. Elizabeth H. Hammond M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert L. Yowell M.D., Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dale G. Renlund M.D
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Heart Failure & Transplantation Service, Harvard Medical School, Bigelow 645, 55 Fruit Street, Boston, Massachusetts, 02114, USA

    G William Dec M.D.

  2. Heart Failure/Transplantation Center, Hahnemann University School of Medicine, Broad and Vine Streets, Mail Stop 115, Philadelphia, Pennsylvania, 19102, USA

    Jagat Narula M.D., Ph.D. (Director) (Director)

  3. Department of Cardiology, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Roure 80, 25198, Lleida, Spain

    Manel Ballester M.D. (Chairman) (Chairman)

  4. Nuclear Medicine Department, Hospital de Sant Pau, Autonomous University of Barcelona, Pare Claret 167, 08025, Barcelona, Spain

    Ignasi Carrio M.D. (Director) (Director)

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media New York

About this chapter

Cite this chapter

Hammond, E.H., Yowell, R.L., Renlund, D.G. (2001). Pathology of Cardiac Allograft Vascular (Microvascular) Rejection: Impact on Patient Outcomes. In: Dec, G.W., Narula, J., Ballester, M., Carrio, I. (eds) Cardiac Allograft Rejection. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1649-1_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-1649-1_6

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-5659-2

  • Online ISBN: 978-1-4615-1649-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation