Distinct phenotypes of cardiac allograft vasculopathy after heart transplantation: A histopathological study

Manon M H Huibers*, Aryan Vink, Johannes Kaldeway, André Huisman, Kim Timmermans, Max Leenders, Marguèrite E I Schipper, Jaap R. Lahpor, Hans J H Kirkels, Corinne Klöpping, Nicolaas de Jonge, Roel A. de Weger

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    Abstract

    Introduction: Long-term survival after heart transplantation (HTx) is hampered by cardiac allograft vasculopathy (CAV). Better understanding of the pathophysiological mechanisms of CAV might have considerable consequences for therapeutic approaches in the future. The aim of the present study was to investigate the histological phenotypes of CAV in relation with clinical patient characteristics. Methods and results: Coronary cross-sections from 51 HTx patients were obtained at autopsy. CAV was observed in 42 patients (82%). Three histological CAV phenotypes were identified (H-CAV 1-3). No CAV (H-CAV 0) is as seen in normal coronary arteries; intimal thickening consisting of a layer of longitudinal oriented smooth muscle cells. In H-CAV 1 to 3 a second intimal layer is formed, on top of the longitudinal oriented smooth muscle cell layer, with predominantly mononuclear inflammatory infiltrate in loose connective tissue (H-CAV 1), smooth muscle cells in different orientation (H-CAV 2), or a fibrotic intimal lesion (H-CAV 3). H-CAV type was significantly related with time after transplantation, age at transplantation, the amount of atherosclerotic disease and the occurrence of infection. In addition, morphometric analysis revealed that higher H-CAV types have a relatively larger intimal area, that is compensated for by expansive arterial remodeling of the artery. Conclusion: CAV in an ongoing process that can be classified into three different phenotypes; inflammatory lesions, lesions rich of smooth muscle cells and fibrotic lesions. Our results suggest that these phenotypes are related to time after transplantation, age at transplantation, the amount of atherosclerotic disease and the occurrence of infection.

    Original languageEnglish
    Pages (from-to)353-359
    Number of pages7
    JournalAtherosclerosis
    Volume236
    Issue number2
    DOIs
    Publication statusPublished - 1 Oct 2014

    Keywords

    • Arterial remodeling
    • Cardiac allograft vasculopathy
    • Heart transplantation
    • Histology

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