Protocol endomyocardial biopsy beyond 6 months—It is time to move on
The optimal duration and frequency of routine surveillance endomyocardial biopsy (EMB) have been questioned in the current era of heart transplantation (HT), where the advances in immunosuppression and donor selection strategies have led to a decline in acute allograft rejection. We investigated the...
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| Veröffentlicht in: | American journal of transplantation 2021-02, Vol.21 (2), p.825-829 |
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| container_title | American journal of transplantation |
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| creator | Oh, Kyung T. Mustehsan, Mohammed H. Goldstein, Daniel J. Saeed, Omar Jorde, Ulrich P. Patel, Snehal R. |
| description | The optimal duration and frequency of routine surveillance endomyocardial biopsy (EMB) have been questioned in the current era of heart transplantation (HT), where the advances in immunosuppression and donor selection strategies have led to a decline in acute allograft rejection. We investigated the utility of routine EMB beyond 6 months post‐HT. A single‐center retrospective review was performed on 2963 EMBs from 220 HT recipients over 10 years. Each EMB was categorized into protocol or symptom‐triggered biopsy and reviewed for rejection. Heart transplant recipients with ≥2 known risk factors for rejection were designated as an elevated risk group. The majority of rejections occurred within 3 months following HT. The yield of routine protocol EMBs was significantly lower than symptom‐triggered EMBs, not only during the first 6 months post‐HT (1.6% vs. 33.3%, P |
| doi_str_mv | 10.1111/ajt.16128 |
| format | Article |
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Surveillance endomyocardial biopsies performed more than 6 months after heart transplant are rarely informative. An editorial from Guerrero‐Miranda and Hall is on page 453.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/ajt.16128</identifier><identifier>PMID: 32515104</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Biopsy ; clinical research/practice ; Graft rejection ; Graft Rejection - etiology ; Heart Transplantation ; heart transplantation/cardiology ; Heart transplants ; Immunosuppression ; Myocardium ; rejection: acute ; Retrospective Studies ; Risk factors</subject><ispartof>American journal of transplantation, 2021-02, Vol.21 (2), p.825-829</ispartof><rights>2020 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>2020 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><rights>2021 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3888-17b9328b1c984011df2c3e0dddf88b3f5081a9be192cce90e81e5ce342b9fe7e3</citedby><cites>FETCH-LOGICAL-c3888-17b9328b1c984011df2c3e0dddf88b3f5081a9be192cce90e81e5ce342b9fe7e3</cites><orcidid>0000-0003-2733-0643</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fajt.16128$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fajt.16128$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32515104$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oh, Kyung T.</creatorcontrib><creatorcontrib>Mustehsan, Mohammed H.</creatorcontrib><creatorcontrib>Goldstein, Daniel J.</creatorcontrib><creatorcontrib>Saeed, Omar</creatorcontrib><creatorcontrib>Jorde, Ulrich P.</creatorcontrib><creatorcontrib>Patel, Snehal R.</creatorcontrib><title>Protocol endomyocardial biopsy beyond 6 months—It is time to move on</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>The optimal duration and frequency of routine surveillance endomyocardial biopsy (EMB) have been questioned in the current era of heart transplantation (HT), where the advances in immunosuppression and donor selection strategies have led to a decline in acute allograft rejection. We investigated the utility of routine EMB beyond 6 months post‐HT. A single‐center retrospective review was performed on 2963 EMBs from 220 HT recipients over 10 years. Each EMB was categorized into protocol or symptom‐triggered biopsy and reviewed for rejection. Heart transplant recipients with ≥2 known risk factors for rejection were designated as an elevated risk group. The majority of rejections occurred within 3 months following HT. The yield of routine protocol EMBs was significantly lower than symptom‐triggered EMBs, not only during the first 6 months post‐HT (1.6% vs. 33.3%, P < .0001), but more so during the 6‐12 months (0.1% vs 83.0%, P < .0001). A similar pattern was observed in heart transplant recipients at both elevated and standard risk for rejection. In conclusion, EMB was found to be a low‐yield screening modality for rejection beyond 6 months post‐HT.
Surveillance endomyocardial biopsies performed more than 6 months after heart transplant are rarely informative. An editorial from Guerrero‐Miranda and Hall is on page 453.</description><subject>Biopsy</subject><subject>clinical research/practice</subject><subject>Graft rejection</subject><subject>Graft Rejection - etiology</subject><subject>Heart Transplantation</subject><subject>heart transplantation/cardiology</subject><subject>Heart transplants</subject><subject>Immunosuppression</subject><subject>Myocardium</subject><subject>rejection: acute</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10D9OwzAYh2ELgWgpDFwAWWKBIa0_O3_ssaqgFCHBUOYocb6IVElc4gSUjUNwAM7CUTgJKSkdkPBiD49eWT9CToGNoTuTaFWPwQcu98gQfMYcH1yxv3sLb0COrF0xBgGX_JAMBPfAA-YOyfyhMrXRJqdYJqZojY6qJItyGmdmbVsaY2vKhPqfH4Up6yf79fa-qGlmaZ0VSGtDC_OC1JTH5CCNcosn23tEHq-vlrMb5-5-vphN7xwtpJQOBLESXMaglXQZQJJyLZAlSZJKGYvUYxIiFSMorjUqhhLQ0yhcHqsUAxQjctF315V5btDWYZFZjXkelWgaG3J3swhTyu3o-R-6Mk1Vdr_rlAyAC6Fkpy57pStjbYVpuK6yIqraEFi4aYXduuHPup092xabuMBkJ3_n7MCkB69Zju3_pXB6u-yT32m2hDE</recordid><startdate>202102</startdate><enddate>202102</enddate><creator>Oh, Kyung T.</creator><creator>Mustehsan, Mohammed H.</creator><creator>Goldstein, Daniel J.</creator><creator>Saeed, Omar</creator><creator>Jorde, Ulrich P.</creator><creator>Patel, Snehal R.</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2733-0643</orcidid></search><sort><creationdate>202102</creationdate><title>Protocol endomyocardial biopsy beyond 6 months—It is time to move on</title><author>Oh, Kyung T. ; Mustehsan, Mohammed H. ; Goldstein, Daniel J. ; Saeed, Omar ; Jorde, Ulrich P. ; Patel, Snehal R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3888-17b9328b1c984011df2c3e0dddf88b3f5081a9be192cce90e81e5ce342b9fe7e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Biopsy</topic><topic>clinical research/practice</topic><topic>Graft rejection</topic><topic>Graft Rejection - etiology</topic><topic>Heart Transplantation</topic><topic>heart transplantation/cardiology</topic><topic>Heart transplants</topic><topic>Immunosuppression</topic><topic>Myocardium</topic><topic>rejection: acute</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oh, Kyung T.</creatorcontrib><creatorcontrib>Mustehsan, Mohammed H.</creatorcontrib><creatorcontrib>Goldstein, Daniel J.</creatorcontrib><creatorcontrib>Saeed, Omar</creatorcontrib><creatorcontrib>Jorde, Ulrich P.</creatorcontrib><creatorcontrib>Patel, Snehal R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oh, Kyung T.</au><au>Mustehsan, Mohammed H.</au><au>Goldstein, Daniel J.</au><au>Saeed, Omar</au><au>Jorde, Ulrich P.</au><au>Patel, Snehal R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Protocol endomyocardial biopsy beyond 6 months—It is time to move on</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2021-02</date><risdate>2021</risdate><volume>21</volume><issue>2</issue><spage>825</spage><epage>829</epage><pages>825-829</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>The optimal duration and frequency of routine surveillance endomyocardial biopsy (EMB) have been questioned in the current era of heart transplantation (HT), where the advances in immunosuppression and donor selection strategies have led to a decline in acute allograft rejection. 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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Biopsy clinical research/practice Graft rejection Graft Rejection - etiology Heart Transplantation heart transplantation/cardiology Heart transplants Immunosuppression Myocardium rejection: acute Retrospective Studies Risk factors |
| title | Protocol endomyocardial biopsy beyond 6 months—It is time to move on |
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