Protocol endomyocardial biopsy beyond 6months-It is time to move on.

Abstract

The optimal duration and frequency of routine surveillance endomyocardial biopsy (EMB) have been questioned in the current era of heart transplantation (HT), where the advances in immunosuppression and donor selection strategies have led to a decline in acute allograft rejection. We investigated the utility of routine EMB beyond 6months post-HT. A single-center retrospective review was performed on 2963 EMBs from 220 HT recipients over 10years. Each EMB was categorized into protocol or symptom-triggered biopsy and reviewed for rejection. Heart transplant recipients with ≥2 known risk factors for rejection were designated as an elevated risk group. The majority of rejections occurred within 3months following HT. The yield of routine protocol EMBs was significantly lower than symptom-triggered EMBs, not only during the first 6months post-HT (1.6% vs. 33.3%, P<.0001), but more so during the 6-12months (0.1% vs 83.0%, P<.0001). A similar pattern was observed in heart transplant recipients at both elevated and standard risk for rejection. In conclusion, EMB was found to be a low-yield screening modality for rejection beyond 6months post-HT.