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Updated: Jul 20, 2026
Murine Heterotopic Heart Transplant Technique
Published on: July 8, 2014
Routine surveillance endomyocardial biopsy continues to detect significant rejection late after heart transplantation
W Q Gradek1, C D'Amico, A L Smith
1Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Surveillance endomyocardial biopsies are crucial even after five years post-heart transplant. These biopsies detect significant rejection episodes, indicating continued monitoring is necessary for cardiac transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- The necessity of ongoing surveillance endomyocardial biopsies after the first year of cardiac transplantation remains debated.
- This study investigates the occurrence of rejection episodes requiring intervention (International Society Heart and Lung Transplantation grade 3A or higher) in patients at least five years post-heart transplant.
Purpose of the Study:
- To determine the incidence of clinically significant rejection in patients five or more years after heart transplantation.
- To assess the safety and efficacy of late-phase surveillance endomyocardial biopsies.
Main Methods:
- A retrospective chart review was performed on patients who underwent endomyocardial biopsy at least five years after heart transplantation.
- Data on rejection episodes (grade 3A or greater) and procedural complications were analyzed.
Main Results:
- Out of 77 patients (461 biopsies) studied, 10% experienced grade 3A or greater rejection episodes.
- Late rejection (years 2-7) occurred in approximately 3.5% to 4% of biopsies.
- Procedural complications were infrequent (<0.5%) and not life-threatening.
Conclusions:
- Clinically significant rejection can occur more than five years after cardiac transplantation.
- Surveillance endomyocardial biopsies are valuable for detecting late rejection, as early rejection does not preclude later events.
- Continued recommendation for surveillance biopsies in late-phase cardiac transplant recipients is supported.
Background:
The need for continued surveillance endomyocardial biopsies beyond the first year after cardiac transplantation is controversial. We evaluated the incidence of rejections requiring treatment (International Society Heart and Lung Transplantation grade 3A or greater) in patients 5 years or more after heart transplantation.
Methods:
We conducted a retrospective chart review of all patients who underwent at least 1 endomyocardial biopsy at our center 5 years or more after heart transplantation.
Results:
A total of 461 biopsies were performed in 77 patients 5 or more years after heart transplantation. Nine episodes of grade 3A or greater rejection were identified in 8 of 77 patients (10%). During the first year, 7.6% of biopsies were grade 3A or greater. Grade 3A rejection occurred in approximately 3.5% to 4% of biopsies during years 2 to 7. The overall incidence of procedural related complications at our institution was < 0.5%.
Conclusion:
Endomyocardial biopsies continue to detect clinically significant rejection beyond 5 years after cardiac transplantation. The overall incidence of procedural related complications requiring treatment was low and none was life threatening. The absence of early rejection does not predict freedom from late rejection. Therefore, we continue to recommend surveillance biopsies in cardiac transplant recipients late after transplantation.
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