Prevalence of the Quilty effect in endomyocardial biopsy of patients after heart transplantation – from cellular rejection to antibody-mediated rejection?

Abstract

The significance of the Quilty effect (QE) is not fully understood. It was once proposed to be related to acute cellular rejection (ACR). We aim to assess the relation between QE prevalence and antibody-mediated rejection (AMR). One thousand three hundred and fifty endomyocardial biopsies (EMBs) from 212 patients who underwent heart transplantation in the years 2001-2013 and survived a period of 30 days after the operation were diagnosed. In all EMBs routine HE staining and additional immunohistochemical staining with polyclonal antibody against C4d were performed. Microscopic findings were classified according to the new ISHLT 2013 criteria. Patients were separated into two groups: group 1 included those with at least one pAMR1 I+ and/or pAMR2 EMB (n = 16), and group 2 included the rest of the patients (n = 196). Presence of QE with distinguishing subtypes A and B (according to the first ISHLT 1990 criteria) was assessed. One hundred and twenty one EMBs from group 1 and 1229 EMBs from group 2 were diagnosed. Quilty effect type A was found in 16 (13.2%) EMBs in group 1 and in 96 (7.8%) EMBs in group 2, p < 0.001. Quilty effect type B was diagnosed in 52 (43%) EMBs in group 1 and in 245 (20%) EMBs in group 2, p < 0.001. The QE was not present in 53 (43.8%) EMBs in group 1 and in 888 (72.2%) EMBs in group 2, p < 0.001. The relation between QE prevalence and AMR is possible as the QE is present statistically more often in EMBs of patients with C4d capillary depositions.

Keywords

• heart transplantation
• antibody-mediated rejection
• Quilty effect
• C4d