Quilty B Lesions on Endomyocardial Biopsies: Are They Associated with Subsequent Histologic Rejection in Cardiac Transplant Patients?

Abstract

616 The Quality effect in endomyocardial biopsy specimens from heart transplant recipients is reported to be benign and unrelated to rejection. The Quilty lesion is further divided into Quilty A lesions and Quilty B lesions. Quilty A lesions are well-differentiated lymphocytes solely in the endocardium. In the Quilty B lesion, lymphocytic infiltration is seen encroaching upon the myocytes sometimes with myocyte injury. There is concern that the Quilty B lesions represent an early form of rejection. To address this, we reviewed 1145 endomyocardial biopsies from January 1, 1997 to October 1, 1997. Of the total, there were 428 Quilty A lesions and 76 Quilty B lesions seen on endomyocardial biopsy. Six of 428 Quilty A lesions (1.4%) and 2 of 76 Quilty B lesions (2.6%) progressed to a grade 3A or greater lesion on subsequent endomyocardial biopsy. There was no clinical evidence of rejection at the time Quilty lesions were noted on endomyocardial biopsy.Conclusion: The presence of Quilty B lesions on endomyocardial biopsies have a low incidence of progression to ≥ 3A rejection on subsequent endomyocardial biopsy similar to the Quilty A lesions. This suggests that both the Quilty A and B lesions do not represent early forms of progressive histologic cardiac rejection.