Less Invasive Acute Rejection Surveillance After Pediatric Heart Transplantation: Experiences From a Low-intensity...

Area of Science:

• Pediatric Cardiology
• Transplantation Immunology
• Graft Monitoring

Background:

• Acute rejection is a major cause of morbidity and mortality post-pediatric heart transplantation (HT).
• Current guidelines rely solely on endomyocardial biopsies (EMB) for rejection surveillance.
• This study explored outcomes of less invasive surveillance in a low-biopsy center setting.

Purpose of the Study:

• To evaluate clinical outcomes of less invasive rejection surveillance in pediatric heart transplant recipients.
• To determine if echocardiography can effectively supplement or replace routine EMB.
• To assess the impact on graft survival and complications.

Main Methods:

• Retrospective analysis of 46 pediatric heart recipients (2011-2021).
• Frequent clinical and echocardiographic evaluations, including tissue Doppler imaging (TDI).
• Protocol EMB at 1 and 2 years post-HT, with additional biopsies based on clinical/echocardiographic changes.

Main Results:

• Graft survival was high (97.8% at 1 year, 95.7% at 2 years) with less invasive surveillance.
• Acute rejection detected in 8.5% of EMB; no protocol EMB in asymptomatic patients showed rejection.
• Absence of reduced TDI velocities and normal clinical status correlated with non-rejection.

Conclusions:

• Combining clinical follow-up with TDI echocardiography is a viable, less invasive rejection surveillance method.
• This approach did not compromise long-term clinical outcomes in pediatric heart transplant recipients.
• Further validation in larger cohorts could reduce invasive biopsies, associated risks, and costs.