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Aim: Graft vessel disease (GVD) is one of the main limiting factors to long-t erm survival after adult heart transplantation (HTx). The incidence of epicardia l and microvascular GVD in paediatric patients was studied. Methods: A total of 137 coronary angiographies from 130 paediatric HTx and heart and lung transplant (HLTx) patients (70 male, 60 female, aged 0-18 y) were evaluated according to the Stanford classification and its supplements (minor vessel alterations). In H &E stainings from right ventricular endomyocardial biopsies (EMB = 397), light microscopic diagnosis of acute cellular rejection (ISHLT classification) and vas cular reaction (morphology of endothelial cells and vessel walls) was performed. Results: Moderate rejection was present in 32.8%and severe rejection in 13.3 %of EMB. Microvascular EC swelling was found in 33.5%and vessel wall thickeni ng in 53.8%of EMB. The results of the coronary angiographic investigations wer e: Stanford lesions = 61.2%, peripheral obliterations = 52.5%, diameter fluc tuations = 86.3%, pathologic tapering = 64.0%, calcifications = 10.8%. Lon g-term survivors (≥5 y) showed macrovascular alterations in 78%of cases and m icrovascular alterations in 67%of cases. Conclusion: The development of micro- and macrovascular GVD is one of the predominant complications in long-term surv ivors after paediatric HTx and HLTx.
Aim: Graft vessel disease (GVD) is one of the main limiting factors to long-term survival after adult heart transplantation (HTx). The incidence of epicardia l and microvascular GVD in pediatric patients was studied. Methods: A total of 137 coronary angiographies from 130 pediatric HTx and heart and lung transplant (HLTx) patients (70 male, 60 female, aged 0-18 y) were evaluated according to the Stanford classification and its supplements (minor vessel alterations). In H & E stainings from right ventricular Results: Moderate rejection was present in 32.8% and severe rejection in 13.3%. Results: Moderate rejection was present in 32.8% and severe rejection in 13.3% of EMB. Microvascular EC swelling was found in 33.5% and vessel wall thickening in 53.8% of EMB. The results of the coronary angiographic investigations wer e: Stanford lesions = 61.2%, peripheral oblite rations = 52.5%, diameter fluc tuations = 86.3%, pathologic tapering = 64.0%, calcifications = 10.8%. Lon g-term survivors (≥5 y) showed macrovascular alterations in 78% of cases and m icrovascular alterations in 67% of cases . Conclusion: The development of micro- and macrovascular GVD is one of the predominant complications in long-term survivors after pediatric HTx and HLTx.