Pathological aspects of a case of cardiac allograft transplantation and a discussion of cardiac rejection

Abstract

A cardiac transplant was carried out on a patient suffering from intractable heart failure due to extensive old antero-septal infarction, the result of severe atherosclerotic coronary artery disease. Death occurred 45 days later following haemorrhage from a perforation in the recipient aorta above the line of anastomosis. To the naked eye the anastomosis appeared healthy but microscopically each aorta was necrotic and contained colonies of cocco-bacilli. These organisms were present in the pericardial cavity and cultures yielded <i>Serratia marcescens</i>. Macroscopic appearances of rejection were not present in the transplanted heart. Microscopically, the myocardium contained foci of myocytolysis and collapse fibrosis; thrombi were present in small blood vessels. Areas of infarction were present in the atria. The left lung contained an abscess from which <i>Pseudomonas pyocyanea and Aspergillus flavus</i> were cultured. There was severe ulceration of the tongue and, to a lesser degree, of the oesophagus around which squamous epithelial cells contained large intranuclear inclusions characteristic of herpes. Spleen and lymph nodes showed striking depletion of lymphoid tissue. It was concluded that there was evidence of minor cardiac rejection in this patient. Evidence of immune suppression was striking and this was accompanied by proliferation of various opportunistic microorganisms which was largely responsible for death.