THE RELATIONSHIP OF QUILTY EFFECT TO ACUTE REJECTION OF THE TRANSPLANTED HEART

Abstract

Introduction. The Quilty Effect (lymphoid-cellular infiltration of the endocardium) is a frequent finding in biopsies of the transplanted heart. The role of this phenomenon in the rejection of the transplanted heart remains unclear. Aim. Retrospective analysis of endomyocardial biopsies of the transplanted heart and assessment of the relationship between acute cellular rejection and Quilty Effect. Methods and results. 112 endomyocardial biopsies with Quilty Effect were identified out of 883 studied biopsies during the period from January 2010 to June 2014. The frequency of Quilty damage occurrence in acute cellular rejection is significantly higher than in its absence (17.7% and 5.6%; р < 0.001). The combination of acute cellular rejection with acute antibodymediated rejection significantly increases the frequency of Quilty damage (р = 0.039). Isolated acute antibodymediated rejection of the transplanted heart does not affect the frequency of Quilty Effect occurrence and is not a direct etiologic and pathogenetic factor of this phenomenon. In the absence of acute cellular rejection, Quilty Effect is a predictor of its later development. Mild acute cellular rejection in conjunction with the Quilty Effect causes the risk of more severe degree of rejection. Quilty Effect type B occurs much less frequently than type A (1.9% and 10.8%; р = 0.001) and is observed primarily in acute cellular rejection of grade G2R (р = 0.001); the frequency of these morphological types at various periods after heart transplant was not significantly different (р > 0.05). Conclusion. The Quilty Effect is a kind of manifestation of acute cellular rejection of the transplanted heart when immunosuppressive therapy with calcineurin inhibitors is used.

Keywords

• quilty effect
• antibody-mediated rejection
• acute cellular rejection
• endomyocardial biopsy
• transplanted heart