title: Vasculitides and eosinophils in endomyocardial biopsies as rejection predictors in heart transplantation.
abstract: BACKGROUND
  The clinical significance of vasculitides, ischemic lesions, Quilty effect and the presence of eosinophils in endomyocardial biopsies of heart transplantation recipients with mild rejection has yet to be established.
  
  
  OBJECTIVE
  To verify whether these histological findings observed in endomyocardial biopsies (eosinophils, vasculitides, Quilty effect and ischemic lesions) are capable of predicting acute graft rejection.
  
  
  METHODS
  A total of 1,012 consecutive endomyocardial biopsies were reevaluated; of these, 939 were classified as OR or 1R according to the Nomenclature of the International Society of Heart and Lung Transplantation of 2005 and divided in two groups: (1) Predictive biopsies: those that preceded acute rejection; and (2) Nonpredictive biopsies: those that did not precede acute rejection. We compared the occurrence of the following histological findings: vasculitides, ischemic lesions, Quilty effect and eosinophils between the groups by uni- and multivariate analyses.
  
  
  RESULTS
  The statistical analysis showed that the presence of severe vasculitides and eosinophils were the best predictors for future acute rejection, with the following odds ratios: 10.60 (95%CI: 3.62 - 31.06. p < 0.001) and 6.26 (95%CI: 3.16 - 12.43, p < 0.001).
  
  
  CONCLUSIONS
  Severe vasculitides and eosinophils in myocardial biopsies are the main predictive factors of acute graft rejection post-heart transplantation.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil. reginaldo@cardiol.br
authors.forename: Reginaldo
authors.initials: R
authors.lastname: Cipullo
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: Finger
authors.forename: João Manoel
authors.initials: JM
authors.lastname: Rossi Neto
authors.forename: Carlos Mendes
authors.initials: CM
authors.lastname: Contreras
authors.forename: Nádia Van Geen
authors.initials: NV
authors.lastname: Poltronieri
authors.forename: Mabel de Moura Barros
authors.initials: Mde M
authors.lastname: Zamorano
authors.forename: Lílian Mary da
authors.initials: LM
authors.lastname: Silva
authors.forename: Paulo
authors.initials: P
authors.lastname: Chaccur
authors.forename: Jarbas Jackson
authors.initials: JJ
authors.lastname: Dinkhuysen
authors.forename: Noedir Antônio Groppo
authors.initials: NA
authors.lastname: Stolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D009202:Cardiomyopathies / Q000473:pathology* / Q000601:surgery; D002648:Child; D004804:Eosinophils / Q000473:pathology*; D004812:Epidemiologic Methods; D005260:Female; D006084:Graft Rejection / Q000473:pathology*; D016027:Heart Transplantation / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D056647:Systemic Vasculitis / Q000145:classification / Q000473:pathology*; D013997:Time Factors; D055815:Young Adult