Impact of Asymptomatic Rejection Steroid Treatment Choice on Subsequent Biopsy Result

Abstract

<h3>Purpose</h3> Guidelines recommend routine surveillance biopsies for the first year after transplant, however the need for treatment of asymptomatic 2R rejection remains controversial. Surveillance strategies across programs are currently highly dynamic with a variety of approaches incorporating non-invasive monitoring techniques. This review was conducted to determine the relationship between 2R rejection steroid treatment intensity and subsequent biopsy findings. <h3>Methods</h3> We conducted a single center, retrospective analysis of heart transplant recipients receiving protocolized biopsies for their first year. Patients with 2R rejection were reviewed for pharmacologic response to 2R rejection and hemodynamic measurements were collected. Statistical analyses using Fishers Exact Test with descriptive statistics were performed. <h3>Results</h3> We reviewed 59 patients transplanted from September 2019 - December 2020 who were an average 50 ± 11 years, were 82% white and 79% male. A total of 78 rejection episodes were analyzed, with subsequent biopsy (Figure 1). When comparing IV steroids use > 250 mg, oral steroid pulse or no pulse, no difference was found for likelihood of subsequent biopsy graded ≥ 2R (24%, 20% and 25% respectively p=0.35). Follow up biopsies were performed an average 15 days post rejection episode. All initial biopsies were protocolized and no rejection were associated with an ejection fraction < 50%. <h3>Conclusion</h3> In our population, steroid choice of treatment for asymptomatic rejection did not impact subsequent biopsy grade. Further opportunities exist to minimize steroid exposure with non-invasive biomarkers and reduction of surveillance biopsies for hemodynamically insignificant rejection.