Bone marrow changes in heart transplant recipients with peripheral cytopenia

Background. We analyzed bone marrow changes in heart transplant recipients who develop peripheral cytopenia and underwent bone marrow biopsy (BMB), We correlated the changes in bone marrow with survival, acute and chronic rej ection, infections, and malignancy, Methods, The test group was constituted of 64 heart transplant recipients w ith peripheral cytopenia, in whom 82 BMBs were performed to assess marrow q uantitative (cellularity, erythropoiesis, myelopoiesis, megakaryopoiesis, f ibrosis, and blast cells) and qualitative (dyserythropoiesis, dysmyelopoies is, and dysmegakaryopoiesis) changes. The control series was constituted of 217 matchable transplant recipients without cytopenia, Statistical analysi s was aimed at assessing whether: (1) cytopenia is an independent risk fact or for survival; (2) acute rejection, chronic rejection, infections, and ma lignancy predict cytopenia; (3) the degree in BMB change allows further str atification of the risk of death; and (4) characteristics and distribution of BMB lesions vary in patients with and without acute and chronic rejectio n, infections, and malignancy. Results. In the test group, BMB specimens showed reduced cellularity in 68% of patients and dysplastic changes of a mild degree affecting all three ma rrow lines (erythropoietic in 88%, myelopoietic in 43%, and megakaryopoieti c in 79%), At statistical analysis, peripheral cytopenia was an independent risk factor for survival, and malignancy proved to be a risk factor for cy topenia, Of BMB specimen changes, only dysmegakaryopoiesis showed a trend a s a negative risk factor for survival. Acute rejection was associated with a high score of erythropoiesis, infections with a low score of dysmegakaryo poiesis, and malignancy with a high score of cellularity. Conclusions. Peripheral cytopenia is an independent risk factor for surviva l in heart transplant recipients, Different marrow changes correlate with t ransplantation-related complications, i.e,, acute rejection, infection, and malignancy.