Heart transplantation without frequent endomyocardial biopsy

Objective The current study aims to evaluate the correlation between serum cyclosporine level, CD 4 /CD 8 ratio, echocardiography and endomyocardial biopsy results after ortrhotopic heart transplantation. Method Twenty-six consecutive patients with mean age 32 ± 9.6 years who underwent orthotopic bicaval heart transplantation were enrolled in this study. Blood sample for serum cyclosporine level, CD 3 ,CD 4 ,CD 8 and CD 4 /CD 8 ratio obtained for each patients, 2 and 4 weeks after transplantation. Likewise immediate echocardiography and endomyocardial biopsy was carried out simultaneously. Results Results of this study showed that 8(30.7%) patients need to readmission for endomyocardial biopsy. Endomyocardial biopsy results, showed rejection grade 1B in three patients, grade 2 in two patient, grade 3A in two patients and grade 0 in only one patients. Likewise echocardiographic evidence of RV and LV dysfunction was detected in all of them. Also CD 4 /CD 8 ratio which indicate level of immunosuppression in these patients was more than 1 in all of them. Serum cyclosporine level was also less than target level in all of these patients. Conclusion EMB is expensive, invasive, inconvenient to the patient, and associated with a significant incidence of serious complications. Therefore, it would be very important for patient care if new no-risk methods would prove to be effective in surveillance of rejection. It seems that a combination of CD 4 /CD 8 ratio, echocardiographic study and serum cyclosporine level can predict the appropriate time of endomyocardial biopsy.