Abstract
<h3>Purpose</h3> Routine endomyocardial biopsies (rEMB) are performed for early detection of allograft rejection, from 1 week to one year after heart transplantation (HT). The optimal frequency of rEMB is unclear in the current era of immunosuppressive agents. Our aim was to investigate the yield of the first rEMB performed a week post HT. <h3>Methods</h3> A single center retrospective analysis on consecutive adult patients undergoing HT between 01/2014 to 09/2021 all had rEMB performed one week after HT. rEMB with International Society for Heart and Lung Transplantation (ISHLT) grade 1R/1B or more was considered as acute cellular rejection (ACR). <h3>Results</h3> A total of 260 patients were included, in 37 (14%) rEMB performed at a median of 7 days [IQR 2] after HT showed ACR. Of these patients, mean age was 51±17, 25 (74%) were males, 14 (38%) had an ISHLT grade 1R/1B rejection, 13 (35%) 1R/2, 9 (24%) 2R/3A and 1 (3%) 3R/4. Only 3 of these 37 patients had none of the following high risk clinical factors: Pre HT panel reactive antibodies class I/II > 20% (n = 12), echocardiogram at EMB day showing left ventricular ejection fraction < 40% (n = 2), continuous sub-therapeutic tacrolimus levels (n = 19), need for mechanical circulatory support during the first week after HT or for vasopressors support until the day of rEMB (n = 6). Two of these 3 patients had 1R/1b rejection with normal echocardiograms at the day of EMB and no change in their immunosuppression was made, while a third patient with 2R/3A ACR, had moderate-severe right ventricular dysfunction on echocardiogram and 6/7 days of sub-therapeutic tacrolimus levels. <h3>Conclusion</h3> The great majority of patients with ACR diagnosed on first week rEMB had at least one high-risk clinical feature suggesting the need for EMB. No patients without any clinical risk factor had 2R rejection or worse. Routine surveillance EMB one week after HT should not be performed absent clinical signs or risk factors for rejection.
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