Related Experiment Videos
Endomyocardial biopsy after heart transplantation in children
H Bhargava1, R M Donner, G Sanchez
1Pediatric Heart Institute, St. Christopher's Hospital for Children, Philadelphia, PA 19133.
Insights
Endomyocardial biopsy is safe and feasible for diagnosing acute graft rejection in pediatric heart transplant recipients. Clinical evaluation and noninvasive tests are insufficient for making treatment decisions.
Area of Science:
- Pediatric Cardiology
- Transplant Immunology
- Graft Rejection Diagnostics
Background:
- Acute graft rejection is a serious complication in pediatric heart transplantation.
- Accurate and timely diagnosis is crucial to prevent graft failure.
- Current diagnostic adjuncts include clinical evaluation, physical examination, and noninvasive testing.
Purpose of the Study:
- To assess the safety and feasibility of repeated endomyocardial biopsy in pediatric heart transplant recipients.
- To evaluate the sensitivity and specificity of clinical and noninvasive data for diagnosing acute graft rejection.
- To determine if clinical findings and noninvasive testing are sufficient for therapeutic judgments.
Main Methods:
- Review of 71 endomyocardial biopsy procedures in seven pediatric heart transplant recipients (aged 6 months to 19 years).
- Assessment of correlation between abnormal clinical/noninvasive findings and biopsy-proven acute rejection.
- Analysis of episodes of treatable rejection occurring without abnormal clinical or noninvasive indicators.
Main Results:
- No serious complications were observed in 71 endomyocardial biopsy procedures.
- Abnormal clinical or noninvasive findings did not consistently coincide with treatable rejection.
- Nine episodes of treatable rejection were identified solely through biopsy, despite normal clinical and noninvasive assessments.
Conclusions:
- Repeated endomyocardial biopsy is a safe and feasible diagnostic tool in pediatric heart transplant patients.
- Clinical evaluation and noninvasive testing are insufficient for guiding therapeutic decisions regarding acute graft rejection.
- Endomyocardial biopsy remains the gold standard for diagnosing acute rejection in this population.
Abstract:
Clinical evaluation, physical examination, and noninvasive testing have been suggested as adjuncts to endomyocardial biopsy for diagnosing acute graft rejection in children after heart transplantation. Because the consequences of delayed diagnosis or unnecessary treatment of rejection may be serious in pediatric transplant recipients, we reviewed our experience with repeated endomyocardial biopsy in seven children (aged 6 months to 19 years) and assessed the sensitivity and specificity of clinical and noninvasive data for diagnosing acute rejection. There were no serious complications in 71 biopsy procedures. In no patient did the presence of abnormal clinical findings or noninvasive testing coincide with treatable rejection that was proved on biopsy. However, there were nine episodes of treatable rejection in the absence of abnormal physical findings or noninvasive studies. At this time we consider repeated endomyocardial biopsy to be a feasible and safe procedure in infants and children and do not consider clinical findings and noninvasive testing sufficient to make therapeutic judgments in regard to acute graft rejection.