Diagnosis of Cardiac Transplant Rejection Using Point-of-Care Ultrasound

Area of Science:

• Cardiology
• Transplant Medicine
• Emergency Medicine

Background:

• Cardiac transplantation is vital for end-stage heart failure but faces challenges from acute cellular rejection and cardiac allograft vasculopathy.
• Endomyocardial biopsy, the diagnostic gold standard, is invasive, driving the need for noninvasive alternatives like echocardiography.
• Point-of-care ultrasound (POCUS) is increasingly available in emergency departments, offering potential for early detection of transplant complications.

Purpose of the Study:

• To highlight the utility of POCUS in the emergency department for diagnosing complications in cardiac transplant recipients.
• To emphasize the role of POCUS in identifying right ventricular dysfunction suggestive of transplant rejection.

Main Methods:

• A case report of a 61-year-old female, 2 years post-cardiac transplant, presenting with nonspecific symptoms to the ED.
• Point-of-care ultrasound (POCUS) was utilized to assess cardiac function, revealing new right ventricular (RV) dilation and strain.
• Findings were correlated with prior laboratory results, right heart catheterization, and subsequent confirmatory endomyocardial biopsy.

Main Results:

• POCUS demonstrated new right ventricular dilation and strain, evidenced by a positive D-sign and increased tricuspid regurgitation.
• These findings raised concern for cardiac transplant failure, prompting further investigation.
• Confirmatory biopsy revealed recurrent acute cellular rejection, despite previous treatment.

Conclusions:

• POCUS is a valuable primary diagnostic tool for emergency physicians managing cardiac transplant patients with nonspecific symptoms.
• POCUS can rapidly identify RV dysfunction and diastolic abnormalities, facilitating early diagnosis of transplant rejection.
• Familiarity with POCUS in this context can refine diagnostic strategies and improve patient outcomes in transplant recipients.