FIBROSIS IN THE TRANSPLANTED HEART AND ITS RELATION TO DONOR ISCHEMIC TIME - ASSESSMENT WITH POLARIZED-LIGHT MICROSCOPY AND DIGITAL IMAGE-ANALYSIS

被引:116
作者
PICKERING, JG
BOUGHNER, DR
机构
[1] UNIV WESTERN ONTARIO, DEPT MED, DIV CARDIOL, LONDON N6A 3K7, ONTARIO, CANADA
[2] UNIV WESTERN ONTARIO, DEPT MED BIOPHYS, LONDON N6A 3K7, ONTARIO, CANADA
[3] JOHN P ROBARTS RES INST, LONDON, ONTARIO, CANADA
关键词
Fibrosis; Heart transplantation; Ischemia; Microscopy;
D O I
10.1161/01.CIR.81.3.949
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Long-distance procurement of cardiac allografts is commonly used to increase the supply of donor organs but has recently been associated with the development of impaired diastolic function. Therefore, the effect of the total ischemic duration on myocardial fibrosis was quantitatively evaluated in 36 cardiac transplant recipients in whom the ischemic time ranged from 70 to 363 (mean, 189±83) minutes. Interstitial collagen was quantified with polarization microscopy and digital image analysis in 115 endomyocardial biopsy specimens taken 5-10 days after surgery. The technique, developed for this study, showed excellent correlation with hydroxyproline analysis (r=0.98, p<0.001). Collagen volume fraction in biopsy specimens from the transplanted hearts was significantly greater than that in biopsy samples from seven normal, age-matched autopsy hearts (4.7±1.9% vs. 2.9±0.6%, p<0.02). The degree of fibrosis correlated with the total ischemic time (r=0.60, p<0.001). Donor age ranged from 10 to 51 years and did not correlate with the degree of fibrosis. No relation was found between the corresponding collagen content and right atrial pressure, pulmonary artery wedge pressure, or cardiac output measured at the time of biopsy. Myocyte damage was observed in eight of the 36 patients and was characterized by a striking loss of muscle birefringence. We conclude that cardiac allograft fibrosis may be identified shortly after transplantation and is dependent on the total ischemic duration.
引用
收藏
页码:949 / 958
页数:10
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