Turk Kardiyol Dern Ars. Ahead of Print: TKDA-64627 | DOI: 10.5543/tkda.2023.64627

Acute Humoral Rejection 12 Days Post-Heart Transplantation with SARS-CoV-2 Antigen Expression in Myocardial Tissue: A Clinical Case

Igor Alexandrovich Makarov, Ekaterina Goncharova, Irina Danilova, Mitrofanova Lubov
Almazov National Medical Research Centre, St. Petersburg, Russia

The development of acute humoral rejection (AMR) in transplanted organs remains a highly relevant and unresolved issue. In this study, we present a clinical case of heart transplantation (HT) in a patient with hypertrophic cardiomyopathy transitioning to a restrictive phenotype in the context of chronic lymphocytic myocarditis. Following HT, the patient developed nosocomial pneumonia, leading to a reduction in immunosuppressive therapy. On the 12th day post-transplantation, a sudden hemodynamic collapse occurred, resulting in a fatal outcome. Autopsy examination revealed acute humoral rejection with a predominance of CD16+ cells in the infiltrate, showing high expression of the SARS-CoV-2 Spike protein on the endothelium and CD16+ cells. Further investigation is required to elucidate the role of SARS-CoV-2 in potential exacerbation of AMR development.

Keywords: Acute humoral rejection, SARS-CoV-2, heart transplantation, cardiac surgery, heart failure: chronic, morphological study, immunohistochemical study

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