Quilty Indicates Increased Risk for Microvasculopathy and Poor Survival After Heart Transplantation

Hiemann, Nicola E.; Knosalla, Christoph; Wellnhofer, Ernst; Lehmkuhl, Hans B.; Hetzer, Roland; Meyer, Rudolf

doi:10.1016/j.healun.2007.11.573

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 27, Issue 3 , Pages 289-296, March 2008

Quilty Indicates Increased Risk for Microvasculopathy and Poor Survival After Heart Transplantation

Nicola E. Hiemann, MD
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
- Reprint requests: Nicola E. Hiemann, MD, Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Telephone: +49-30-4593-1715. Fax: +49-30-4593-1704.
Christoph Knosalla, MD, PhD
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
Ernst Wellnhofer, MD
- Department of Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
Hans B. Lehmkuhl, MD
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
Roland Hetzer, MD, PhD
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
Rudolf Meyer, MD, PhD
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany

Received 24 October 2007; received in revised form 24 October 2007; accepted 26 November 2007.

Background

The impact of Quilty (sub-endocardial infiltration of lymphocytes) on the development of stenotic microvasculopathy and outcome after heart transplantation has not yet been evaluated.

Methods

Biopsies (n = 9,713) obtained within the first post-transplant year from 873 patients (722 men, age 49.3 ± 0.3 years) were evaluated by light microscopy (hematoxylin–eosin) for Quilty and cellular rejection (ISHLT), stenotic microvasculopathy (luminal radius:medial thickness ratio <1) and endothelial disease (core diameter:cell diameter ratio ≤1). Risk factors for stenotic microvasculopathy were analyzed by logistic regression. Overall survival and freedom from graft failure (cardiac re-transplantation, myocardial infarction and sudden cardiac death) were estimated by the Kaplan–Meier method and tested using a Cox proportional hazard model.

Results

We found 1,830 (19%) Quilty-positive biopsies in 481 (55%) Quilty-formers and stenotic microvasculopathy in 866 (9%) biopsies of 379 (43%) patients. Evidence of Quilty (odds ratio [OR] 1.77; 95% confidence interval [CI] 1.26 to 2.57) and endothelial disease (OR 4.98; 95% 95% CI 3.31 to 7.49) indicated higher risk, whereas post-transplant statin therapy was associated with lower risk for stenotic microvasculopathy (OR 0.68; 95% CI 0.48 to 0.97). Freedom from graft failure was lower in Quilty-formers (p = 0.0060) and even worse if patients suffered from both Quilty and stenotic microvasculopathy (p = 0.0017). Both factors were confirmed in multivariate regression analysis (stenotic microvasculopathy risk ratio [RR] 1.90, 95% CI 1.23 to 2.95; Quilty RR 1.77, 95% CI 1.11 to 2.82, p = 0.0430).

Conclusions

Presence of Quilty indicates increased risk for stenotic microvasculopathy in biopsy early after heart transplantation. Both are associated with poor outcome due to graft failure.