Limited Utility of Endomyocardial Biopsy in the First Year after Heart Transplantation

Abstract

The yield of BPAR was low in the AZA group and very low in the MMF group. The incidence of complications was also low, but repeated biopsies led to a higher rate per patient. Routine surveillance EMBs and the frequency of such biopsies should be reevaluated in the light of their low yield with current immunosuppression.

Usefulness of routine surveillance endomyocardial biopsy 6 months after heart transplantation

“…These results confirm the previous observation of a low incidence of significant, biopsy-detected rejection in patients receiving triple immunosuppression (CsA, MMF or azathioprine, and prednisone) within the first year after OHT. 15 In our cohort, however, the total incidence of significant rejection between 6 and 24 months was 3.3% (16 of 465) in the standard group compared with 6.4% (6 of 92) in the conservative group. The explanation for the higher incidence in the conservative group is that EMB was performed only as clinically indicated by symptoms or echocardiographic findings, resulting in a higher yield of EMB-detected rejections (Table 2).…”

Radiation exposure after heart transplantation: Trends and significance

“…This result is not surprising because the largest contributor to radiation dose, cardiac procedures (in particular endomyocardial biopsies), are routinely and most frequently done during first year of transplantation. 13 Cumulative radiation by year and the lifetime cancer risk estimates are reported in Table 2. The 10-year cumulative dose of 84 mSv represents an additional 1 in 290 (0.34%) new cancers in the healthy population.…”

Pathology of cardiovascular interventions and surgery

“…44 Current advances in effectiveness of immunosuppression regimens and reduction in incidence and severity of acute rejection suggest that the role of EMBs in the first year after transplantation for clinical surveillance needs to be reconsidered. 45 Disease recurrence in the graft heart has been observed in eosinophilic cardiomyopathy, giant cell myocarditis, sarcoidosis and light-chain amyloidosis, and biopsy is useful in monitoring possible recurrence. 46 Heart tissue samples are obtained by percutaneous insertion of a biopsy catheter with attached cutting pinchers, also called a 'bioptome' (commonly the Stanford Bioptome), through a sheath which is first advanced into a vein or artery.…”