Acute cellular rejection after heart transplantation and its remission visualized by cardiac magnetic resonance

Abstract

Recent advances of parametric mapping techniques have allowed cardiac magnetic resonance (CMR) to effectively detect acute cellular rejection (ACR) after heart transplantation. Herein, we share CMR findings in two cases of ACR. A 45-year-old man who underwent orthotopic heart transplantation for anthracycline-induced cardiomyopathy was scheduled for a surveillance biopsy at week 12 posttransplantation. Histopathologic findings of his right ventricular endomyocardial biopsy revealed multiple foci of lymphocyte infiltration with myocyte damage [International Society of Health and Lung Transplantation (ISHLT) Grade 2R, Panel A]. CMR showed diffusely prolonged native T1 (1345± 43 ms, Panel B) and T2 (53.7 ± 1.4 ms) values. We treated him with methylprednisolone 1000 mg daily for 3 days followed by a tapered regimen, namely prednisolone 25 mg daily for 2 days, 20 mg daily for 2 days, and 15 mg daily for maintenance at discharge. Eight days after the first biopsy, his follow-up CMR showed reduced native T1 (1298 ± 45 ms, Panel C) and T2 (50.8 ± 1.1 ms; T2-weighted images and native T2 mapping; see Supplementary material online, Figure S1) values, and biopsy revealed no acute