BACKGROUND: The need for continued surveillance endomyocardial biopsies beyond the first year after cardiac transplantation is controversial. We evaluated the incidence of rejections requiring treatment (International Society Heart and Lung Transplantation grade 3A or greater) in patients 5 years or more after heart transplantation. METHODS: We conducted a retrospective chart review of all patients who underwent at least 1 endomyocardial biopsy at our center 5 years or more after heart transplantation. RESULTS: A total of 461 biopsies were performed in 77 patients 5 or more years after heart transplantation. Nine episodes of grade 3A or greater rejection were identified in 8 of 77 patients (10%). During the first year, 7.6% of biopsies were grade 3A or greater. Grade 3A rejection occurred in approximately 3.5% to 4% of biopsies during years 2 to 7. The overall incidence of procedural related complications at our institution was < 0.5%. CONCLUSION: Endomyocardial biopsies continue to detect clinically significant rejection beyond 5 years after cardiac transplantation. The overall incidence of procedural related complications requiring treatment was low and none was life threatening. The absence of early rejection does not predict freedom from late rejection. Therefore, we continue to recommend surveillance biopsies in cardiac transplant recipients late after transplantation.
BACKGROUND: The need for continued surveillance endomyocardial biopsies beyond the first year after cardiac transplantation is controversial. We evaluated the incidence of rejections requiring treatment (International Society Heart and Lung Transplantation grade 3A or greater) in patients 5 years or more after heart transplantation. METHODS: We conducted a retrospective chart review of all patients who underwent at least 1 endomyocardial biopsy at our center 5 years or more after heart transplantation. RESULTS: A total of 461 biopsies were performed in 77 patients 5 or more years after heart transplantation. Nine episodes of grade 3A or greater rejection were identified in 8 of 77 patients (10%). During the first year, 7.6% of biopsies were grade 3A or greater. Grade 3A rejection occurred in approximately 3.5% to 4% of biopsies during years 2 to 7. The overall incidence of procedural related complications at our institution was < 0.5%. CONCLUSION: Endomyocardial biopsies continue to detect clinically significant rejection beyond 5 years after cardiac transplantation. The overall incidence of procedural related complications requiring treatment was low and none was life threatening. The absence of early rejection does not predict freedom from late rejection. Therefore, we continue to recommend surveillance biopsies in cardiac transplant recipients late after transplantation.
Authors: David M Peng; Victoria Y Ding; Seth A Hollander; Tigran Khalapyan; John C Dykes; David N Rosenthal; Christopher S Almond; Charlotte Sakarovitch; Manisha Desai; Doff B McElhinney Journal: Pediatr Transplant Date: 2018-12-01
Authors: Robert J H Miller; Louise Thomson; Ryan Levine; Sadia J Dimbil; Jignesh Patel; Jon A Kobashigawa; Evan Kransdorf; Debiao Li; Daniel S Berman; Balaji Tamarappoo Journal: Clin Transplant Date: 2019-09-25 Impact factor: 2.863
Authors: Kevin P Daly; Audrey C Marshall; Julie A Vincent; Warren A Zuckerman; Timothy M Hoffman; Charles E Canter; Elizabeth D Blume; Lisa Bergersen Journal: J Heart Lung Transplant Date: 2011-12-30 Impact factor: 10.247
Authors: Filip K Swirski; Moritz Wildgruber; Takuya Ueno; Jose-Luiz Figueiredo; Peter Panizzi; Yoshiko Iwamoto; Elizabeth Zhang; James R Stone; Elisenda Rodriguez; John W Chen; Mikael J Pittet; Ralph Weissleder; Matthias Nahrendorf Journal: J Clin Invest Date: 2010-06-23 Impact factor: 14.808
Authors: Matthew D Zinn; Michael J Wallendorf; Kathleen E Simpson; Ashley D Osborne; James K Kirklin; Charles E Canter Journal: Pediatr Transplant Date: 2018-01-29
Authors: Craig R Butler; Richard Thompson; Mark Haykowsky; Mustafa Toma; Ian Paterson Journal: J Cardiovasc Magn Reson Date: 2009-03-12 Impact factor: 5.364