Cellular rejection of the conduction system after orthotopic heart transplantation for congenital atrioventricular block.
We report a case of severe acute cellular rejection of the cardiac allograft conduction system in a 15-month-old girl who received orthotopic heart transplantation (OHT) for congestive heart failure from a congenital heart block. Post-operatively, the patient was treated for clinical evidence of rejection, but did not have electrocardiographic findings of heart block. Six weeks after transplantation, the patient developed sudden-onset bradycardia and died. Autopsy showed severe acute cellular rejection involving primarily the conduction system. Cellular rejection of the cardiac conduction system is a potentially lethal complication of OHT. Although diagnostic modalities to predict or detect ongoing cellular rejection in the conduction system are limited, recognizing the early signs, such as post-operative heart block, may prevent devastating consequences.
Chan
Jessica B
JB
Department of Pathology and Laboratory Medicine, University of California at Los Angeles, Los Angeles, California 90095-1732, USA. jchan@mednet.ucla.edu <jchan@mednet.ucla.edu>
Levi
Daniel S
DS
Lai
Chi K
CK
Alejos
Juan C
JC
Fishbein
Michael C
MC
D001919:Bradycardia / Q000209:etiology; D004562:Electrocardiography; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology*; D006327:Heart Block / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006329:Heart Conduction System / Q000166:cytology / Q000473:pathology* / Q000503:physiopathology; D016027:Heart Transplantation / Q000009:adverse effects* / Q000473:pathology; D006801:Humans; D007223:Infant; D014184:Transplantation, Homologous