Incidence of Acute Rejection Compared With Endomyocardial Biopsy Complications for Heart Transplant Patients in the Contemporary Era.
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
15 Dec 2023
15 Dec 2023
Historique:
medline:
15
12
2023
pubmed:
15
12
2023
entrez:
15
12
2023
Statut:
aheadofprint
Résumé
The reference standard of detecting acute rejection (AR) in adult heart transplant (HTx) patients is an endomyocardial biopsy (EMB). The majority of EMBs are performed in asymptomatic patients. However, the incidence of treated AR compared with EMB complications has not been compared in the contemporary era (2010-current). The authors retrospectively analyzed 2769 EMBs obtained in 326 consecutive HTx patients between August 2019 and August 2022. Variables included surveillance versus for-cause indication, recipient and donor characteristics, EMB procedural data and pathological grades, treatment for AR, and clinical outcomes. The overall EMB complications rate was 1.6%. EMBs performed within 1 mo after HTx compared with after 1 mo from HTx showed significantly increased complications (OR, 12.74, P < 0.001). The treated AR rate was 14.2% in the for-cause EMBs and 1.2% in the surveillance EMBs. We found the incidence of AR versus EMB complications was significantly lower in the surveillance compared with the for-cause EMB group (OR, 0.05, P < 0.001). We also found the incidence of EMB complications was higher than treated AR in surveillance EMBs. The yield of surveillance EMBs has declined in the contemporary era, with a higher incidence of EMB complications compared with detected AR. The risk of EMB complications was highest within 1 mo after HTx. Surveillance EMB protocols in the contemporary era may need to be reevaluated.
Sections du résumé
BACKGROUND
BACKGROUND
The reference standard of detecting acute rejection (AR) in adult heart transplant (HTx) patients is an endomyocardial biopsy (EMB). The majority of EMBs are performed in asymptomatic patients. However, the incidence of treated AR compared with EMB complications has not been compared in the contemporary era (2010-current).
METHODS
METHODS
The authors retrospectively analyzed 2769 EMBs obtained in 326 consecutive HTx patients between August 2019 and August 2022. Variables included surveillance versus for-cause indication, recipient and donor characteristics, EMB procedural data and pathological grades, treatment for AR, and clinical outcomes.
RESULTS
RESULTS
The overall EMB complications rate was 1.6%. EMBs performed within 1 mo after HTx compared with after 1 mo from HTx showed significantly increased complications (OR, 12.74, P < 0.001). The treated AR rate was 14.2% in the for-cause EMBs and 1.2% in the surveillance EMBs. We found the incidence of AR versus EMB complications was significantly lower in the surveillance compared with the for-cause EMB group (OR, 0.05, P < 0.001). We also found the incidence of EMB complications was higher than treated AR in surveillance EMBs.
CONCLUSIONS
CONCLUSIONS
The yield of surveillance EMBs has declined in the contemporary era, with a higher incidence of EMB complications compared with detected AR. The risk of EMB complications was highest within 1 mo after HTx. Surveillance EMB protocols in the contemporary era may need to be reevaluated.
Identifiants
pubmed: 38098137
doi: 10.1097/TP.0000000000004882
pii: 00007890-990000000-00622
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Références
Caves PK, Stinson EB, Billingham ME, et al. Diagnosis of human cardiac allograft rejection by serial cardiac biopsy. J Thorac Cardiovasc Surg. 1973;66:461–466.
Agbor-Enoh S, Shah P, Tunc I, et al.; GRAfT Investigators. Cell-free DNA to detect heart allograft acute rejection. Circulation. 2021;143:1184–1197.
Kim PJ, Olymbios M, Siu A, et al. A novel donor-derived cell-free DNA assay for the detection of acute rejection in heart transplantation. J Heart Lung Transplant. 2022;41:919–927.
Khush KK, Patel J, Pinney S, et al. Noninvasive detection of graft injury after heart transplant using donor-derived cell-free DNA: a prospective multicenter study. Am J Transplant. 2019;19:2889–2899.
Anthony C, Imran M, Pouliopoulos J, et al. Cardiovascular magnetic resonance for rejection surveillance after cardiac transplantation. Circulation. 2022;145:1811–1824.
Bermpeis K, Esposito G, Gallinoro E, et al. Safety of right and left ventricular endomyocardial biopsy in heart transplantation and cardiomyopathy patients. JACC Heart Fail. 2022;10:963–973.
Strecker T, Rösch J, Weyand M, et al. Endomyocardial biopsy for monitoring heart transplant patients: 11-years-experience at a German heart center. Int J Clin Exp Pathol. 2013;6:55–65.
Deckers JW, Hare JM, Baughman KL. Complications of transvenous right ventricular endomyocardial biopsy in adult patients with cardiomyopathy: a seven-year survey of 546 consecutive diagnostic procedures in a tertiary referral center. J Am Coll Cardiol. 1992;19:43–47.
Hamour IM, Burke MM, Bell AD, et al. Limited utility of endomyocardial biopsy in the first year after heart transplantation. Transplantation. 2008;85:969–974.
Hull JV, Padkins MR, Hajj SE, et al. Risks of right heart catheterization and right ventricular biopsy: a 12-year, single-center experience. Mayo Clin Proc. 2023;98:419–431.
Subherwal S, Kobashigawa JA, Cogert G, et al. Incidence of acute cellular rejection and non-cellular rejection in cardiac transplantation. Transplant Proc. 2004;36:3171–3172.
Moayedi Y, Foroutan F, Miller RJH, et al. Risk evaluation using gene expression screening to monitor for acute cellular rejection in heart transplant recipients. J Heart Lung Transplant. 2019;38:51–58.
Khush KK, Perch M, Zuckermann A, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-eighth adult heart transplantation report—2021; focus on recipient characteristics. J Heart Lung Transplant. 2021;40:1035–1049.
Jäämaa-Holmberg S, Salmela B, Lemström K, et al. Cancer incidence and mortality after heart transplantation—a population-based national cohort study. Acta Oncol. 2019;58:859–863.
Holzhauser L, DeFilippis EM, Nikolova A, et al. The end of endomyocardial biopsy? A practical guide for noninvasive heart transplant rejection surveillance. JACC Heart Fail. 2023;11:263–276.
Velleca A, Shullo MA, Dhital K, et al. The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2022;42:e1–e141.
Stewart S, Winters Gayle L, Fishbein MC, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant. 2005;24:1710–1720.
Inker LA, Eneanya ND, Coresh J, et al.; Chronic Kidney Disease Epidemiology Collaboration. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med. 2021;385:1737–1749.
Rodgers N, Gerding B, Cusi V, et al. Comparison of two donor-derived cell-free DNA tests and a blood gene-expression profile test in heart transplantation. Clin Transplant. 2023;37:e14984.
Berry GJ, Burke MM, Andersen C, et al. The 2013 International Society for Heart and Lung Transplantation Working Formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation. J Heart Lung Transplant. 2013;32:1147–1162.
Williams MJ, Lee MY, DiSalvo TG, et al. Biopsy-induced flail tricuspid leaflet and tricuspid regurgitation following orthotopic cardiac transplantation. Am J Cardiol. 1996;77:1339–1344.
Weckbach LT, Maurer U, Schramm R, et al. Lower frequency routine surveillance endomyocardial biopsies after heart transplantation. PLoS One. 2017;12:e0182880.
Denys BG, Uretsky BF, Reddy PS. Ultrasound-assisted cannulation of the internal jugular vein: a prospective comparison to the external landmark-guided technique. Circulation. 1993;87:1557–1562.
Blomström-Lundqvist C, Noor AM, Eskilsson J, et al. Safety of transvenous right ventricular endomyocardial biopsy guided by two-dimensional echocardiography. Clin Cardiol. 1993;16:487–492.
Ragni T, Martinelli L, Goggi C, et al. Echo-controlled endomyocardial biopsy. J Heart Transplant. 1990;9:538–542.
Fyfe B, Loh E, Winters GL, et al. Heart transplantation-associated perioperative ischemic myocardial injury morphological features and clinical significance. Circulation. 1996;93:1133–1140.
Kaczorowski DJ, Nakao A, Vallabhaneni R, et al. Mechanisms of Toll-like receptor 4 (TLR4)-mediated inflammation after cold ischemia/reperfusion in the heart. Transplantation. 2009;87:1455–1463.
Shah KB, Flattery MP, Smallfield MC, et al. Surveillance endomyocardial biopsy in the modern era produces low diagnostic yield for cardiac allograft rejection. Transplantation. 2015;99:e75–e80.
Jarcho JA. Fear of rejection–monitoring the heart-transplant recipient. N Engl J Med. 2010;362:1932–1933.
Colvin MM, Cook JL, Chang P, et al.; American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology. Antibody-mediated rejection in cardiac transplantation: emerging knowledge in diagnosis and management: a scientific statement from the American Heart Association. Circulation. 2015;131:1608–1639.
Coutance G, Kransdorf E, Aubert O, et al. Clinical prediction model for antibody-mediated rejection: a strategy to minimize surveillance endomyocardial biopsies after heart transplantation. Circ Heart Fail. 2022;15:e009923.
Bruneval P, Angelini A, Miller D, et al. The XIIIth Banff conference on allograft pathology: the Banff 2015 heart meeting report: improving antibody-mediated rejection diagnostics: strengths, unmet needs, and future directions. Am J Transplant. 2017;17:42–53.
Pham MX, Teuteberg JJ, Kkfoury AG, et al. Gene-expression profiling for rejection surveillance after cardiac transplantation. N Engl J Med. 2010;362:1890–1900.
Kobashigawa J, Patel J, Azarbal B, et al. Randomized pilot trial of gene expression profiling versus heart biopsy in the first year after heart transplant: early invasive monitoring attenuation through gene expression trial. Circ Heart Fail. 2015;8:557–564.
Mehra MR, Parameshwar J. Gene expression profiling and cardiac allograft rejection monitoring: is IMAGE just a mirage? J Heart Lung Transplant. 2010;29:599–602.
Orrego CM, Cordero-Reyes AM, Estep JD, et al. Usefulness of routine surveillance endomyocardial biopsy 6 months after heart transplantation. J Heart Lung Transplant. 2012;31:845–849.
Starling RC, Stehlik J, Baran DA, et al.; CTOT-05 Consortium. Multicenter analysis of immune biomarkers and heart transplant outcomes: results of the clinical trials in organ transplantation-05 study. Am J Transplant. 2016;16:121–136.
Klingenberg R, Koch A, Schnabel PA, et al. Allograft rejection of ISHLT grade ≥3A occurring late after heart transplantation—a distinct entity? J Heart Lung Transplant. 2003;22:1005–1013.