Quilty Lesions in the Endomyocardial Biopsies after Heart Transplantation.

J Pathol Transl Med

Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Published: January 2019

Background: The aim of this study was to investigate the clinical significance of Quilty lesions in endomyocardial biopsies (EMBs) of cardiac transplantation patients.

Methods: A total of 1190EMBs from 117 cardiac transplantation patients were evaluated histologically for Quilty lesions,acute cellular rejection, and antibody-mediated rejection. Cardiac allograft vasculopathy wasdiagnosed by computed tomography coronary angiography. Clinical information, including thepatients' survival was retrieved by a review of medical records.

Results: Eighty-eight patients(75.2%) were diagnosed with Quilty lesions, which were significantly associated with acute cellularrejection, but not with acute cellular rejection ≥ 2R or antibody-mediated rejection. In patientsdiagnosed with both Quilty lesions and acute cellular rejection, the time-to-onset of Quilty lesionsfrom transplantation was longer than that of acute cellular rejections. We found a significant associationbetween Quilty lesions and cardiac allograft vasculopathy. No significant relationship wasfound between Quilty lesions and the patients' survival.

Conclusions: Quilty lesion may be an indicator of previous acute cellular rejection rather than a predictor for future acute cellular rejection.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344801PMC
http://dx.doi.org/10.4132/jptm.2018.11.30DOI Listing

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Article Synopsis
  • Endomyocardial biopsy (EMB) is crucial for detecting heart transplant rejections but suffers from inconsistent manual interpretation by pathologists, leading to unnecessary treatments and poor outcomes.
  • A new AI system has been developed to automate the analysis of EMB images, accurately detecting various types and grades of allograft rejection with high performance metrics.
  • In comparison to traditional methods, this AI system not only maintains equivalent accuracy but also reduces variability among different human reviewers, potentially enhancing the effectiveness of heart transplant monitoring.
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The XVth Banff Conference on Allograft Pathology meeting was held on September 23-27, 2019, in Pittsburgh, Pennsylvania, USA. During this meeting, two main topics in cardiac transplant pathology were addressed: (a) Improvement of endomyocardial biopsy (EMB) accuracy for the diagnosis of rejection and other significant injury patterns, and (b) the orphaned lesion known as Quilty effect or nodular endocardial infiltrates. Molecular technologies have evolved in recent years, deciphering pathophysiology of cardiac rejection.

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Quilty Lesions in the Endomyocardial Biopsies after Heart Transplantation.

J Pathol Transl Med

January 2019

Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: The aim of this study was to investigate the clinical significance of Quilty lesions in endomyocardial biopsies (EMBs) of cardiac transplantation patients.

Methods: A total of 1190EMBs from 117 cardiac transplantation patients were evaluated histologically for Quilty lesions,acute cellular rejection, and antibody-mediated rejection. Cardiac allograft vasculopathy wasdiagnosed by computed tomography coronary angiography.

View Article and Find Full Text PDF

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Cardiac allograft rejection is typically diagnosed on the basis of hematoxylin and eosin (H&E) histology of endomyocardial biopsies. This diagnosis is made based on the degree of immune cell infiltrate and associated myocyte damage. However, considerable variability in rejection grading between pathologists can occur.

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