Pulmonary interstitial fibrosis and haemosiderin-laden macrophages: late following heart transplantation

• Published in: Respiratory medicine Vol. 90; no. 9; pp. 547 - 551
• Main Authors: Egan, J.J., Martin, N., Hasleton, P.S., Yonan, N., Rahman, A.N., Campbell, C.A., Deiraniya, A.K., Carroll, K.B., Woodcock, A.A.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.10.1996; Elsevier
• Subjects: Biological and medical sciences; Bronchoalveolar Lavage; Bronchoscopy; Cytomegalovirus Infections - complications; Female; Heart Transplantation - pathology; Hemosiderin - metabolism; Humans; Lung - physiopathology; Macrophages - metabolism; Macrophages - pathology; Male; Medical sciences; Middle Aged; Pneumonia, Pneumocystis - complications; Postoperative Period; Prospective Studies; Pulmonary Fibrosis - complications; Pulmonary Fibrosis - pathology; Pulmonary Fibrosis - physiopathology; Respiratory Function Tests; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Heart; Human; Respiratory disease; Lung; Cardiovascular disease; Exploration; Transplantation; Homotransplantation; Pathology; Gases; Treatment; Biopsy; Bronchoalveolar lavage; Surgery; Fibrosis; Transfer; Complication; Gas exchange; Diagnosis; Pneumopathy
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/S0954-6111(96)90147-X

Impairment of pulmonary diffusion is recognized following heart transplantation. This study was undertaken to determine the histopathological basis for the defect in pulmonary physiology. Heart transplant recipients (HTR) entered into a prospective study of post-transplant pulmonary physiology were asked to undergo bronchoscopy, bronchoalveolar lavage (BAL) and transbronchial biopsy ( n = 18) in the presence of impaired gas transfer. Transbronchial biopsies were examined under light microscopy and demonstrated focal interstitial fibrosis in 12 patients, cytomegalovirus disease in four patients and Pneumocystis carinii pneumonia in three patients. Bronchoalveolar lavage differential counts were normal in HTR but BAL macrophages contained haemosiderin. The histological features of interstitial fibrosis may underlie the fall in gas transfer seen following heart transplantation. The presence of haemosiderin-laden macrophages late following heart transplantation suggests a capillary leak syndrome.