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[Heart transplantation: life-long biopsies for prevention of rejection?]
T Stallmach1, A Gaspert, J Ersch
1Departement Pathologie, Universitätsspital Zürich. thomas.stallmach@pty.usz.ch
Insights
Heart transplantation improves patient quality of life. However, monitoring for cardiac allograft rejection via invasive endomyocardial biopsies shows only moderate interobserver agreement among pathologists, necessitating new methods.
Area of Science:
- Cardiology
- Pathology
- Transplantation Immunology
Abstract:
The transplantation of a heart restores the quality of life and productivity to patients who have experienced severe loss of contractility of heart muscle during an infection or as a result of long-lasting chronic heart disease. Monitoring for allograft rejection requires expensive procedures whereby, with catheterisation of the right heart, endomyocardial biopsies are retrieved. Evaluation by the pathologist uses a standardised diagnostic scheme which is in use worldwide. We have tested the interobserver agreement in a very heterogeneous group of examining pathologists and found moderate agreement with a kappa value of 0.52. The development of other methods to improve and even to replace invasive procedures for monitoring acceptance/rejection of a cardiac allograft requires interdisciplinary cooperation.