Strategies for routine biopsies in heart transplantation based on 8-year results with more than 13, 000 biopsies

Abstract

The endomyocardial biopsy (EMB) in heart transplant recipients has beenconsidered the "gold standard" for diagnosis of graft rejection (REJ). Thepurpose of this retrospective study is to develop long-term strategies(frequency and postoperative duration of EMB) for REJ monitoring. Between1985 and 1992, 346 patients (mean age 44.5 years, female patients = 14%)received 382 heart grafts. For graft surveillance EMBs were performedaccording to a fixed schedule depending on postoperative day and theresults of previous biopsies. In the first year the average number (no.) ofEMBs/patient was 20 with 19% positive for REJ in the first quarter, dropping to 7% REJ/EMB by the end of the first year. The percentage ofREJ/EMB declined annually from 4.7% to 4.5%, 2.2% and less than 1% afterthe fifth year. Individual biopsy results in the first 3 postoperativemonths had little predictive value. Patients with fewer than two REJ (group1), vs patients with two or more REJ in the first 6 postoperative months(group 2), were significantly less likely to reject in the second half ofthe first year (group 1: 0.29 +/- 0.6 REJ/patient; group 2:0.83 +/- 1.3REJ/patient; P < 0.001) and third postoperative year (group 1:0.12 +/-0.33 REJ/patients; group 2:0.46 +/- 0.93 REJ/patient; P < 0.05). Inconclusion, routine EMBs in the first 3 postoperative months have onlylimited predictive value, however the number of routine EMBs can bedrastically reduced later depending on the intermediate postoperative REJpattern. © 1995, Springer-Verlag.