Acute 2R Cellular Rejection on Routine Surveillance Endomyocardial Biopsy is Not Associated with Significant Hemodynamic Changes on Right Heart Catheterization

• Published in: The Journal of heart and lung transplantation Vol. 41; no. 4; pp. S455 - S456
• Main Authors: Yunis, A., Tsao, L., Coglianese, E., Lewis, G.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2022
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2022.01.1150

Routine surveillance endomyocardial biopsy (EMB) following heart transplantation (HT) is considered an important tool for early detection of allograft rejection. However, the recommended frequency of EMB is not defined by societal guidelines and scheduling practices are widely variable between transplant centers. We sought to identify whether there were differences in hemodynamic, echocardiographic or outcome parameters between patients categorized by rejection grade on surveillance EMB. We examined LVEF by echocardiography and right heart catheterization (RHC) hemodynamic parameters obtained at the time of routine surveillance EMB in 222 patients who underwent HT between January 2015 - January 2021 at a single center. On the first four post-transplant paired EMBs and RHCs, similar hemodynamic measurements and LVEFs were observed regardless of corresponding cellular rejection grade (P > 0.5) (Table 1). Patients were then grouped by if they ever had a biopsy with significant rejection (SR) defined as ≥ grade 2R (n=119, 54%) or no significant rejection (NSR) defined as grade 0 or 1R (n=103, 46%). Kaplan-Meier survival analysis showed no significant difference in post-transplant survival (HR 0.56, p=0.14) in SR vs NSR (Figure 1). A total of 26 deaths were observed (16 NSR and 10 SR). For those that died in the SR group, only one may have been related to allograft rejection with the cause of death being outside hospital sudden death. In a SR sub-group of 39 patients with ≥3 episodes of grade 2R mortality was low (n=3, 8%). We observed minimal hemodynamic, echocardiographic or prognostic implications of cellular rejection detected by routine surveillance EMB. These findings lend support to the practice of limiting high frequency routine surveillance EMB in post-HT patients, even in the early period when non-invasive diagnostics are not applicable.