title: HLA-DRB1 typing by micro-bead array assay identifies the origin of early lymphoproliferative disorder in a heart transplant recipient.
abstract: We report the case of a 68-year-old woman who underwent heart transplantation for hypertrophic cardiomyopathy. Two months after the transplant she developed mild fever and dyspnea with a marked drop in left ventricle ejection fraction of 31%. Coronary angiography was negative for cardiac allograft vasculopathy. Endomyocardial biopsy revealed ischemic damage with no evidence of acute cellular rejection, antibody-mediated rejection or viral myocarditis. A neoplastic process was suspected even though full-body computerized tomography was negative for malignancy. The patient died 4 months after transplantation. The autopsy showed acute antero-septal myocardial infarction due to a nodular epicardial EBV-related posttransplant lymphoproliferative disorder (PTLD) infiltrating the left anterior descending coronary artery with occlusive neoplastic thrombosis. We highlight two major aspects of this case: (1) the unusual occurrence of early PTLD involving the cardiac allograft and causing a fatal outcome, (2) the application of an immunological technique for HLA-DRB1 typing to posttransplant paraffin-embedded autopsy material to identify the recipient origin of this early malignancy, thus excluding a possible donor-transmitted neoplasm.
authors: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
authors: M
authors: M
authors: Fedrigo
authors: F
authors: F
authors: Poli
authors: G
authors: G
authors: Esposito
authors: G
authors: G
authors: Feltrin
authors: G
authors: G
authors: Toscano
authors: C
authors: C
authors: d'Agostino
authors: B
authors: B
authors: Schiavon
authors: G
authors: G
authors: Gerosa
authors: A
authors: A
authors: Amadori
authors: M
authors: M
authors: Valente
authors: G
authors: G
authors: Thiene
authors: A
authors: A
authors: Angelini
mesh_terms: D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000601:surgery* / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000821:virology; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology; D059811:HLA-DRB1 Chains / Q000235:genetics*; D016027:Heart Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006650:Histocompatibility Testing; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000209:etiology; D020411:Oligonucleotide Array Sequence Analysis; D011183:Postoperative Complications
chemical_list: D004279:DNA, Viral; D059811:HLA-DRB1 Chains