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Vascular rejection in cardiac transplantation

Between November 1983 and January 1990 103 orthotopic heart transplants were performed at the National Hospital, University of Oslo, Norway. Twenty‐two patients died. Acute and/or chronic rejection was the cause of death in nine, disseminated infection in eight, cancer in three, and cerebral haemorrhage in one of the patients. Two patients were successfully retransplanted after graft failure due to ABO blood group incompatibility because of a communication error. One patient with a positive lymphocytotoxic crossmatch died shortly posttransplant due to acute circulatory collapse. The cumulative one‐ and five‐year survivals were 82% and 68%. Follow‐up time was 226.6 graft years, survival range from one to 2,306 days (mean 803 ± 4.12 SEM). A total of 1,343 endomyocardial biopsies were performed, which revealed 181 acute cellular rejection episodes, and 22 biopsies revealed acute and/or chronic vascular rejection. Autopsy studies showed three general types of vascular damage: acute (necrotizing) vasculitis, atherosclerotic disease in the epicardial arteries and diffuse proliferative arteriopathy in the intramural and smaller branches. In several cases acute vasculitis was concomitant with either of the two chronic types of accelerated graft sclerosis. Tissue immunofluorescence analysis demonstrated vascular deposition of immunoglobulin and complement in acute vasculitis, indicative of humoral immunoreaction. Postoperatively early chronic vascular rejection may develop.