Don't Take Another Piece of My Heart: Substantial Reduction in Biopsies with Initiation of Non-Invasive Rejection Surveillance at One Month Post-Transplant

Abstract

<h3>Purpose</h3> Historically, the standard of care for post heart transplant (HT) rejection surveillance has been endomyocardial biopsies (EMB), with the majority of biopsies in the first 6 months. <h3>Methods</h3> This was a retrospective analysis of adult HT recipients from 1/2018 to 12/2020 at a single institution. All patients without multiorgan transplants were considered for non-invasive monitoring starting at 28 days. Patients were excluded from analysis if they died within 55 days post HT or moved to another transplant center within first year post transplant. Patients were analyzed in six month cohorts based on transplant date. The primary outcomes were the number of EMB performed in first six months and one year survival. <h3>Results</h3> A total of 106 HT recipients were included and divided into six cohorts. Distribution of biopsies by cohort is shown in Figure 1. Patients in later cohorts had fewer EMB in the first six months post transplant compared to those at the initiation of protocol (p<0.01). The July 2018 and July 2019 cohorts each had two patients expire, making their one year survival 88% and 87% respectively. All other cohorts had 100% survival. There was no difference in one year survival between cohorts (p=0.07) (Figure 2). Baseline characteristics, immunosuppression and use of induction was similar between groups. <h3>Conclusion</h3> Initiation of non-invasive rejection at surveillance at 28 days post-transplant significantly reduces the number of biopsies and results in similar 1 year survival As providers increasingly use non-invasive monitoring, the number of early EMB continue to decline.