Related Experiment Video
Updated: Jun 7, 2025
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Decreasing Endomyocardial Biopsy Frequency in Pediatric Heart Transplantation Using A Rejection Risk Prediction
Drishti Tolani1, Ryan J Butts1, David L Sutcliffe2
1Division of Pediatric Cardiology, UT Southwestern Medical Center, Dallas, Texas, USA.
Insights
Implementing a rejection risk score in pediatric heart transplantation reduced endomyocardial biopsies by 60% without impacting rejection-free survival. This demonstrates the score
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Immunology
Background:
- Rejection remains a significant cause of morbidity and mortality following pediatric heart transplantation (HT).
- Endomyocardial biopsy (EMB) is the standard for rejection diagnosis but carries procedural risks.
- Center-specific variations exist in EMB frequency, highlighting the need for optimized surveillance protocols.
Purpose of the Study:
- To evaluate the impact of a novel rejection risk prediction score on endomyocardial biopsy frequency and early post-transplant outcomes.
- To compare outcomes in the first year after pediatric heart transplantation before and after the implementation of a risk-based EMB schedule.
Main Methods:
- A retrospective review of pediatric patients (≤18 years) undergoing heart transplantation between January 2015 and December 2020.
- Patients were divided into two eras: pre-score implementation (Era 1) and post-score implementation (Era 2).
- The primary endpoint was 1-year rejection-free survival; comparisons included freedom from rejection and rejection with hemodynamic compromise (RHC) using Kaplan-Meier analysis.
Main Results:
- A total of 115 patients were analyzed (52 in Era 1, 63 in Era 2), with increased Ventricular Assist Device (VAD) utilization in Era 2.
- No significant differences in demographic or clinical variables were observed between the eras.
- The median number of EMBs per patient in the first year post-HT decreased by 60% after score implementation (5 in Era 1 vs. 2 in Era 2, p < 0.001), without compromising freedom from rejection or RHC.
Conclusions:
- Implementation of a rejection risk prediction score successfully reduced the frequency of endomyocardial biopsies in pediatric heart transplant recipients.
- This strategy achieved a significant reduction in EMBs without negatively affecting early post-transplant outcomes, demonstrating clinical applicability.
- The risk score facilitates a more tailored approach to surveillance, potentially minimizing procedural risks associated with frequent EMBs.
Background:
Rejection remains an important cause of morbidity and mortality after pediatric heart transplantation (HT). Endomyocardial biopsy (EMB) is the gold standard for rejection diagnosis, but it comes with procedural risk. The frequency of EMB varies significantly across centers. Since April 2018, our center's surveillance EMB schedule is based on a rejection risk prediction score employing age, pre-HT diagnosis, and panel reactive antibodies (PRA). We aimed to evaluate outcomes in the 1st year post-HT before and after risk score implementation.
Methods:
Patients who underwent HT at our center at ≤ 18 years of age from January 2015 to December 2020 were reviewed. The primary endpoint was rejection-free survival at 1 year-post- HT. Clinical characteristics were compared for patients transplanted in Era 1 (January 2015-April 2018) and Era 2 (April 2018-December 2020). Cumulative 1-year survival free from rejection and from rejection with hemodynamic compromise (RHC) was compared between eras using Kaplan-Meier survival analysis.
Results:
115 patients underwent HT during our study period (52 in Era 1 and 63 in Era 2). There was an increase in VAD utilization between eras (19% in Era 1 vs. 40% in Era 2, p = 0.025), but otherwise no significant difference in demographic or clinical variables between the two eras. No statistically significant difference in freedom from rejection or freedom from RHC was identified between the two eras. There was a 60% reduction in the median number of EMB per patient in the first year post-HT after employing the score (5 in Era 1 vs. 2 in Era 2, p < 0.001).
Conclusions:
After employing a rejection risk prediction score, our center decreased the frequency of EMB without worsening early post-HT outcomes, thus establishing the clinical applicability of this tool.
More Related Videos
09:16Isolation and Characterization of Cardiac Mesenchymal Stromal Cells from Endomyocardial Bioptic Samples of Arrhythmogenic Cardiomyopathy Patients
Published on: February 28, 2018
06:45A Modified Cuff Technique for Mouse Cervical Heterotopic Heart Transplantation Model
Published on: February 7, 2022