Lower frequency routine surveillance endomyocardial biopsies after heart transplantation.
In heart transplantation (HTx) patients, routine surveillance endomyocardial biopsies (rsEMB) are recommended for the detection of early cardiac allograft rejection. However, there is no consensus on the optimal frequency of rsEMB. Frequent rsEMB have shown a low diagnostic yield in the new era of p...
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doaj-c5f45d438f264a12bce5097eb17034ef2020-11-25T00:27:02ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01128e018288010.1371/journal.pone.0182880Lower frequency routine surveillance endomyocardial biopsies after heart transplantation.Ludwig T WeckbachUlrich MaurerRene SchrammBruno C HuberKorbinian LackermairMax WeissBruno MeiserChristian HaglSteffen MassbergSandra EifertUlrich GrabmaierIn heart transplantation (HTx) patients, routine surveillance endomyocardial biopsies (rsEMB) are recommended for the detection of early cardiac allograft rejection. However, there is no consensus on the optimal frequency of rsEMB. Frequent rsEMB have shown a low diagnostic yield in the new era of potent immunosuppressive regimen. Efficacy and safety of lower frequency rsEMB have not been investigated so far. In this retrospective, single centre, observational study we evaluated 282 patients transplanted between 2004 and 2014. 218 of these patients were investigated by rsEMB and symptom-triggered EMB (stEMB). We evaluated EMB results, complications, risk factors for rejection, survival 1 and 5 years as well as incidence of cardiac allograft vasculopathy (CAV) 3 years after HTx. A mean of 7.1 ± 2.5 rsEMB were conducted per patient within the first year after HTx identifying 7 patients with asymptomatic and 9 patients with symptomatic acute rejection requiring glucocorticoide pulse therapy. Despite this relatively low frequency of rsEMB, only 6 unscheduled stEMB were required in the first year after HTx leading to 2 additional treatments. In 6 deaths among all 282 patients (2.1%), acute rejection could not be ruled out as a potential underlying cause. Overall survival at 1 year was 78.7% and 5-year survival was 74%. Incidence of CAV was 17% at 3-year follow-up. Morbidity and mortality of lower frequency rsEMB are comparable with data from the International Society for Heart and Lung Transplantation (ISHLT) registry. Consensus is needed on the optimal frequency of EMB.http://europepmc.org/articles/PMC5571958?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ludwig T Weckbach Ulrich Maurer Rene Schramm Bruno C Huber Korbinian Lackermair Max Weiss Bruno Meiser Christian Hagl Steffen Massberg Sandra Eifert Ulrich Grabmaier |
spellingShingle |
Ludwig T Weckbach Ulrich Maurer Rene Schramm Bruno C Huber Korbinian Lackermair Max Weiss Bruno Meiser Christian Hagl Steffen Massberg Sandra Eifert Ulrich Grabmaier Lower frequency routine surveillance endomyocardial biopsies after heart transplantation. PLoS ONE |
author_facet |
Ludwig T Weckbach Ulrich Maurer Rene Schramm Bruno C Huber Korbinian Lackermair Max Weiss Bruno Meiser Christian Hagl Steffen Massberg Sandra Eifert Ulrich Grabmaier |
author_sort |
Ludwig T Weckbach |
title |
Lower frequency routine surveillance endomyocardial biopsies after heart transplantation. |
title_short |
Lower frequency routine surveillance endomyocardial biopsies after heart transplantation. |
title_full |
Lower frequency routine surveillance endomyocardial biopsies after heart transplantation. |
title_fullStr |
Lower frequency routine surveillance endomyocardial biopsies after heart transplantation. |
title_full_unstemmed |
Lower frequency routine surveillance endomyocardial biopsies after heart transplantation. |
title_sort |
lower frequency routine surveillance endomyocardial biopsies after heart transplantation. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2017-01-01 |
description |
In heart transplantation (HTx) patients, routine surveillance endomyocardial biopsies (rsEMB) are recommended for the detection of early cardiac allograft rejection. However, there is no consensus on the optimal frequency of rsEMB. Frequent rsEMB have shown a low diagnostic yield in the new era of potent immunosuppressive regimen. Efficacy and safety of lower frequency rsEMB have not been investigated so far. In this retrospective, single centre, observational study we evaluated 282 patients transplanted between 2004 and 2014. 218 of these patients were investigated by rsEMB and symptom-triggered EMB (stEMB). We evaluated EMB results, complications, risk factors for rejection, survival 1 and 5 years as well as incidence of cardiac allograft vasculopathy (CAV) 3 years after HTx. A mean of 7.1 ± 2.5 rsEMB were conducted per patient within the first year after HTx identifying 7 patients with asymptomatic and 9 patients with symptomatic acute rejection requiring glucocorticoide pulse therapy. Despite this relatively low frequency of rsEMB, only 6 unscheduled stEMB were required in the first year after HTx leading to 2 additional treatments. In 6 deaths among all 282 patients (2.1%), acute rejection could not be ruled out as a potential underlying cause. Overall survival at 1 year was 78.7% and 5-year survival was 74%. Incidence of CAV was 17% at 3-year follow-up. Morbidity and mortality of lower frequency rsEMB are comparable with data from the International Society for Heart and Lung Transplantation (ISHLT) registry. Consensus is needed on the optimal frequency of EMB. |
url |
http://europepmc.org/articles/PMC5571958?pdf=render |
work_keys_str_mv |
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