Cardiac Transplants With Cyclosporin-A and Low-Dose Prednisone: Histologic Graduation of Rejection.

CARDIAC histology has been reviewed in 16 patients between April 1980 and March 1981 to evaluate the effect of cyclosporin-A (CyA) and low-dose prednisone in a new trial of orthotopic cardiac transplantation. The usual maintenance dose of CyA has been 5-10 mg/kg/day, and prednisone 15-20 mg/ day.1 HydrOC()rtisone, 1 g intravenously, has been used to combat rejection. usually without alteration of the prednisone dose. Ninety-two endomyocardial biopsies have been performed and a minimum of three specimens from each evaluated by light microscopy. Each specimen is fixed in 10% buffered formalin and stained with hematoxylin and eosin. Masson's trichrome. and methyl-green pyronine. No mortality but some morbidity has resulted from the percutaneous endomyocardial biopsy; pericardial tamponade occurred once 6 hr following a procedure, and a second patient formed a superior mediastinal hematoma. Morphological features and grading of rejection by endomyocardial biopsy is based on those described by Billingham for patients receiving conventional immunosuppression with azathioprine. antithymocyte globulin. and prednisone." In this series. miid rejection has included varied degrees of lymphocytic endocardial infiltration, focal interstitial infiltration, and endocardial plus interstitial edema (Fig. 1). Moderate rejection occurs with increased monocytic infiltration and moderate myocyte necrosis. The latter feature distinguishes this group of eyA-treated patients from those treated with conventional immunosuppression in whom myocyte necrosis is rare and focal. Severe rejection has occurred with widespread necrosis and inflammation (Fig. 2). Increased active fibrosis and scar formation have been prominent following myocyte necrosis, and mild to mod-