[Quantification of cell proliferation with the proliferation marker MIB-1 in endomyocardial biopsies after heart transplantation. An aid in diagnosis of graft rejection needing treatment?].
The histological grading of endomyocardial biopsies still represents the gold standard in the diagnosis of cardiac allograft rejections. Severe acute rejections (grade 3A/3B, ISHLT) after heart transplantation require immediate high-dose immunosuppressive therapy. The histomorphological differentiation to the rejection requiring no therapy (grade 2) is often difficult. The aim of this study is the improvement of the diagnostic identification of therapy-requiring rejections using quantification of cell proliferation in the inflammatory infiltrate of biopsies. 322 consecutive endomyocardial biopsies from 48 heart allograft recipients were immunohistochemically investigated using the monoclonal antibody MIB-1 binding selectively to the proliferation associated antigen Ki 67. Fifty percent of all biopsies showed cell proliferation: 47.0% in absent or mild rejection (0, 1A, 1B) compared to 88.0% in moderate to severe rejection (2, 3A/3B) (p < 0.01). Proliferating cells were arranged in a focal or perivascular pattern in 66.0% and diffuse in 34.0%. The quantity of proliferating cells per biopsy--but not the pattern--correlated with the grade of rejection: 0.7% in grade 0, 1.4%/5% in 1A/1B, 8.5% in grade 2 up to 18.7% in 3A/3B, and 2.7% in R1 (p < 0.01, ccorr = 0.65). The amount of proliferating mononuclear cells in the inflammatory infiltrate in acute cardiac allograft rejection is proportional to the severity of the rejection and thus an aid in the difficult histological differentiation of grade 3A/3B.
Universitätsklinikum, RWTH Aachen.
S
S
Gerbaulet
M
M
Sigmund
S
S
Hauptmann
U
U
Janssens
D000208:Acute Disease; D000328:Adult; D000911:Antibodies, Monoclonal; D002455:Cell Division / Q000187:drug effects / Q000502:physiology*; D004699:Endocardium / Q000473:pathology*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000473:pathology*; D016027:Heart Transplantation / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D019394:Ki-67 Antigen / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D019394:Ki-67 Antigen
Quantifizierung der Zellproliferation mittels des Proliferationsmarkers MIB-1 in endomyokardialen Biopsien nach Herztransplantation. Eine Hilfe bei der Diagnostik der therapiebedürftigen Abstossungsreaktion?