Usefulness of routine surveillance endomyocardial biopsy 6 months after heart transplantation

Orrego, Carlos M.; Cordero‐Reyes, Andrea M.; Estep, Jerry D.; Loebe, Matthias; Torre‐Amione, Guillermo

doi:10.1016/j.healun.2012.03.015

Cited by 34 publications

(23 citation statements)

References 19 publications

(15 reference statements)

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“…DSA titers provide additional data that could prove useful in the identification of patients more or less likely to have capillary C4d deposition at biopsy, a hallmark indicator of AMR . This advantage would be most beneficial in following asymptomatic pediatric patients given the value of early detection of AMR and the benefits of minimizing scheduled EMB surveillance . Further, this study reinforces the importance for standardization of methods for determining DSA across centers to more readily share data, facilitate multicenter studies, and establish best practices.…”

Section: Discussionmentioning

confidence: 57%

Donor‐specific antibodies: Can they predict C4d deposition in pediatric heart recipients?

Peng

Law

Kemna

et al. 2013

Pediatric Transplantation

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There is limited evidence regarding the utility of circulating DSA in surveillance for AMR of pediatric heart recipients. Our hypothesis is that quantitation of DSA improves their power for predicting a C4d+, an integral component in the current diagnostic criteria of AMR. All pediatric recipients transplanted between 10/2005 and 1/2011 were retrospectively reviewed for DSA determined within 48 h of EMB. C4d+ was defined as >25% endothelial cell staining by immunohistochemical methods. A total of 183 paired DSA-EMB determinations were identified in 60 patients, a median of three paired studies per patient (range: 1-9). DSA were detected in 60 of these determinations. A receiver-operating characteristic plot identified a threshold single-antibody MFI of >6000 that strongly correlated with C4d+ (p < 0.0001) with a high negative predictive value (0.97) and specificity (0.95). The sensitivity and positive predictive values were 0.71 and 0.60, respectively. The predictive power of single-antigen DSA for C4d deposition was improved in pediatric heart recipients using an institution-specific MFI threshold value. In post-transplant care, quantitative DSA should be an essential component in the surveillance for AMR.

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Section: Discussionmentioning

confidence: 57%

Donor‐specific antibodies: Can they predict C4d deposition in pediatric heart recipients?

Peng

Law

Kemna

et al. 2013

Pediatric Transplantation

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“…Recently, Orrego et al shared their center’s experience with a conservative biopsy protocol, showing that complete discontinuation of EMB in asymptomatic patients at 6 months after heart transplant was feasible with acceptable outcomes. (13) Without a contemporaneous control group, the investigators could not define the effect and safety of their strategy.…”

Section: Discussionmentioning

confidence: 99%

Surveillance Endomyocardial Biopsy in the Modern Era Produces Low Diagnostic Yield for Cardiac Allograft Rejection

et al. 2015

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Background The changing epidemiology of cardiac allograft rejection has prompted many to question the yield of surveillance endomyocardial biopsy (EMB) in heart transplant (HT) patients. We sought to determine the yield of EMB in the modern era. Methods We evaluated 2,597 EMBs in 182 consecutive HT patients who survived to their first EMB. EMBs were categorized as asymptomatic or clinically driven and were compared based on era of antiproliferative therapy use at our center (early azathioprine era: 1990–2000 vs. modern mycophenolate era: 2000–2011). Results In the modern era, patients had a higher prevalence of risk factors for developing rejection (≥ ISHLT grade 2R); however the frequency of rejection was decreased at all times (0–6 months: 60.2% vs. 21.5%, P < 0.001, 6–12 months: 26.8% vs. 1.8%, P < 0.001, 12–36 months: 32.3% vs. 10.5%, P = 0.006). The yield of asymptomatic EMB decreased in the modern era between 0–6 months (10.9% vs. 3.12%), 6–12 months (17% vs. 0 %), and years 2–3 (6.1% vs. 1.5%). In the early era, the odds ratio of rejection during asymptomatic EMB compared to a clinically driven EMB was 0.47 (95% CI: 0.31–0.71) and was decreased in the modern era (0.17[0.07–0.42], P = 0.04). The probability of detecting rejection on asymptomatic EMB was significantly reduced in the modern era, even after adjustment for tacrolimus and induction therapy (1% vs. 8%, P < 0.001). Conclusions The clinical yield of surveillance EMB has decreased in the modern era. EMB in asymptomatic patients >6 months after HT warrants further scrutiny.

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“…EMB is a rather invasive modality compared to other tests such as echocardiography and MRI . However, it is still the most important examination, being the ‘gold standard’ to monitor acute rejection . In our study population, 23 patients (46%) experienced mild and moderate ACR, and three patients (6%) had AMR within the first year.…”

Section: Discussionmentioning

confidence: 92%

The pathological implications of heart transplantation: Experience with 50 cases in a single center

Ishibashi‐Ueda

Ikeda

Matsuyama

et al. 2014

Pathology International

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Heart transplantation started in Japan in 1999. Since then, 50 transplants have been performed at our center. We performed histopathological analyses of the 50 explanted hearts and the post-transplant biopsy specimens. The median age of recipients was 39 years. The primary diseases before transplant were idiopathic dilated cardiomyopathy in 33 patients (66%), hypertrophic cardiomyopathy in seven (14%), restrictive cardiomyopathy in one, arrhythmogenic right ventricular cardiomyopathy in one, and secondary cardiomyopathy in eight (16%). Before transplantation, 47 patients (94%) had left ventricular assist devices. No severe cardiovascular failure due to allograft rejection occurred. The post-transplant survival rate was 97.6% at 1 year and 93.1% at 10 years. One recipient was lost to sepsis from myelodysplastic syndrome in the fourth year, one died of multiple organ failure and peritonitis 8 months after transplant. Another patient died of recurrent posttransplant lymphoproliferative disorders (PTLD). Mild cardiac dysfunction occurred in seven recipients in the early postoperative period. Moderate acute cellular rejection occurred in six patients (12%), and antibody-mediated rejection occurred in three (6%). The number of heart transplants performed in Japan is very small. However, the outstanding 10-year survival rate is due to donor evaluation and posttransplant care resulting in low grade rejection. Pathological evaluation has also greatly contributed to the results.

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Usefulness of routine surveillance endomyocardial biopsy 6 months after heart transplantation

Cited by 34 publications

References 19 publications

Donor‐specific antibodies: Can they predict C4d deposition in pediatric heart recipients?

Donor‐specific antibodies: Can they predict C4d deposition in pediatric heart recipients?

Surveillance Endomyocardial Biopsy in the Modern Era Produces Low Diagnostic Yield for Cardiac Allograft Rejection

The pathological implications of heart transplantation: Experience with 50 cases in a single center

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