Trends in Post-Heart Transplant Biopsies for Graft Rejection versus Non-Rejection

Abstract

Purpose With alternatives to surveillance endomyocardial biopsies (EMBs) post-orthotopic heart transplant (OHT) now available (such as gene expression profiling), we evaluated the current utilization of EMBs for hospitalized patients post-OHT. Both surveillance EMBs (in patients without complications) and in the setting of graft complications were evaluated. Methods The 2004-2014 National Inpatient Sample database was used to assess trends of inpatient EMB (ICD-9 code 37.25) in OHT patients (ICD-9 V42.1, excluding the transplant procedure itself). ICD-9 996.83 was used to identify OHT complications including rejection. Annual trends in in-hospital mortality, length of stay (LOS), and cost of care were determined. Results There was no significant change in the number of EMBs performed over the study period (p=0.44). Of 37,955 EMBs, 2283 (6%) were in the setting of OHT complications. EMBs in OHT complications did not showed a significant increase in LOS (p=0.06), but had a significant increase in cost over time (P=0.001) (Fig 1). However, LOS on average was 5 days longer (p<0.001) and $88,816 higher cost compared to hospitalizations in non-complication EMB (p<0.001). In-patient mortality decreased over time for both groups (p<0.001), with higher odds of inpatient mortality with OHT complications (odds ratio 1.87; 95%CI, 1.70-2.05). Conclusion The vast majority of in-hospital EMBs were not related to OHT complications. Nevertheless, EMB hospitalizations with OHT complications including rejection showed significantly greater LOS and cost compared to those without complications. Furthermore, cost has increased over the study period. With alternatives to surveillance endomyocardial biopsies (EMBs) post-orthotopic heart transplant (OHT) now available (such as gene expression profiling), we evaluated the current utilization of EMBs for hospitalized patients post-OHT. Both surveillance EMBs (in patients without complications) and in the setting of graft complications were evaluated. The 2004-2014 National Inpatient Sample database was used to assess trends of inpatient EMB (ICD-9 code 37.25) in OHT patients (ICD-9 V42.1, excluding the transplant procedure itself). ICD-9 996.83 was used to identify OHT complications including rejection. Annual trends in in-hospital mortality, length of stay (LOS), and cost of care were determined. There was no significant change in the number of EMBs performed over the study period (p=0.44). Of 37,955 EMBs, 2283 (6%) were in the setting of OHT complications. EMBs in OHT complications did not showed a significant increase in LOS (p=0.06), but had a significant increase in cost over time (P=0.001) (Fig 1). However, LOS on average was 5 days longer (p<0.001) and $88,816 higher cost compared to hospitalizations in non-complication EMB (p<0.001). In-patient mortality decreased over time for both groups (p<0.001), with higher odds of inpatient mortality with OHT complications (odds ratio 1.87; 95%CI, 1.70-2.05). The vast majority of in-hospital EMBs were not related to OHT complications. Nevertheless, EMB hospitalizations with OHT complications including rejection showed significantly greater LOS and cost compared to those without complications. Furthermore, cost has increased over the study period.