title: Endomyocardial biopsy findings after photopheresis treatment of cardiac transplant rejection.
abstract: Photopheresis is a potential therapy for allograft rejection in which reinfusion of mononuclear cells exposed to ultraviolet-A irradiation after pretreatment with 8-methoxypsoralen may initiate immunosuppressive responses. Endomyocardial biopsies (EMBs) of cardiac transplant recipients with moderate acute rejection (IHSLT grades 2 and 3) treated with photopheresis (7 patients/9 treatments) and followed for six months or more were evaluated and compared with biopsies of patients treated with corticosteroids (7 patients/8 treatments) and followed for a similar time period. The first posttreatment EMB showed improvement in 100% of corticosteroid-treated patients, compared with 56% of photopheresis-treated patients (p < 0.005). Interstitial infiltrates of >90% T-lymphocytes were present in a greater percentage of photopheresis-treated patients than in corticosteroid-treated patients on the first five posttreatment EMBs (p < 0.005) as follows: EMB 1, 90% vs. 25%; EMB 2, 90% vs. 25%; EMB 3, 78% vs. 0%; EMB 4, 56% vs. 0%, EMB 5, 56% vs. 0%. Postphotopheresis EMBs also showed giant cell reaction in 1 patient and extensive band-like infiltrates in 3 patients. Our results suggest that interstitial T-cell infiltrates are more prevalent and persist longer after photopheresis than after corticosteroid treatment of heart allograft rejection. Whether these T-lymphocytes are alloreactive or mediate immunosuppressive signals is unknown. The use of new immunosuppressive therapies may modify endomyocardial biopsy findings, requiring adjustment of the diagnostic criteria for assessing and grading allograft rejection.
authors.affiliation: Departments of Pathology and Medicine, Loyola University of Chicago, Maywood, Illinois, USA.
authors.forename: G L
authors.initials: GL
authors.lastname: Winters
authors.affiliation: Section of Cardiology, Loyola University of Chicago, Maywood, Illinois, USA.
authors.forename: M
authors.initials: M
authors.lastname: Costanzo-Nordin
authors.affiliation: Section of Rheumatology, Loyola University of Chicago, Maywood, Illinois, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Hubbell
authors.affiliation: Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Wilson
authors.affiliation: Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska USA.
authors.forename: B M
authors.initials: BM
authors.lastname: McManus
authors.affiliation: Section of Cardiology, Loyola University of Chicago, Maywood, Illinois, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Johnson
authors.affiliation: Section of Rheumatology, Loyola University of Chicago, Maywood, Illinois, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Robinson