Circulation, Vol 81, 949-958, Copyright © 1990 by American Heart Association
JG Pickering and DR Boughner
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 less than 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 less than 0.02). The degree of
fibrosis correlated with the total ischemic time (r = 0.60, p less than
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.
ARTICLES
Fibrosis in the transplanted heart and its relation to donor ischemic time. Assessment with polarized light microscopy and digital image analysis
Department of Medicine, University of Western Ontario, London, Canada.
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