Pathologic assessment of cardiomyocytes in heart transplant recipients treated with rapamycin or cyclosporine.
The aim of this study was to compare cardiomyocytes and stromal pathology in heart transplant recipients treated with rapamycin (RAPA) versus cyclosporine (CyA). We analyzed elective biopsies obtained during first 3 months after heart transplantation in four patients treated with RAPA (24 biopsies) and seven patients receiving CyA (49 biopsies). Additional medications in both groups consisted of mycophenolate mofetil or azathioprine and prednisone. The intensity of rejection was assessed using the ISHLT scale; it was comparable in both groups based upon the number of results showing significant rejection and the average biopsy scores. Each slide was also examined under high-power magnification to sarcoplasmic and nuclear changes. Sarcoplasmic vacuolation, premyocytolysis and myocytolysis, nuclear staining, stromal fibrosis and edema, presence of vasculopathy, and lymphocytes infiltrating the myocardium occurred more frequently in the CyA group. The difference in the degree of hyperchromasia of the nuclei was highly significant (67% versus 10%, P <.00001). Our findings suggest that despite comparable levels of rejection as assessed using the ISHLT scale, patients treated with RAPA display fewer signs of cardiomyocytic alterations early after heart transplantation.
Zakliczynski
M
M
Department of Cardiac Surgery and Transplantation, Silesian Center for Heart Disease, Zabrze, Poland. zaklimed@onet.pl
Nozynski
J
J
Swierad
M
M
Konecka-Mrowka
D
D
Zembala
M
M
D001706:Biopsy; D002467:Cell Nucleus / Q000473:pathology; D016572:Cyclosporine / Q000627:therapeutic use*; D016027:Heart Transplantation / Q000276:immunology* / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008214:Lymphocytes / Q000473:pathology; D032342:Muscle Cells / Q000473:pathology*; D009206:Myocardium / Q000473:pathology*; D012519:Sarcoplasmic Reticulum / Q000473:pathology; D020123:Sirolimus / Q000627:therapeutic use*; D014617:Vacuoles / Q000473:pathology
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D020123:Sirolimus