ROUTINE SURVEILLANCE ENDOMYOCARDIAL BIOPSY - LATE REJECTION AFTER HEART-TRANSPLANTATION

Background. Transplant programs use routine surveillance endomyocardia l biopsies (RSEMB), which are performed at preset intervals to diagnos e cardiac rejection. This retrospective study determined the incidence of graft rejection detected by RSEMB. Methods. The records of 95 pati ents who underwent heart transplantation between 1987 and 1995 were re viewed. Rejection incidence was recorded for 80 patients who survived at least 30 days, with a mean follow-up of 35 months. Results. One tho usand five hundred sixteen total biopsies were performed; 1,170 were R SEMB. Four hundred seventy-five total rejection episodes occurred and 269 (56%) were diagnosed by RSEMB. Two distinct patient groups were id entified. The majority (70 patients), had a decline in the incidence o f rejection and no rejection episodes were identified by RSEMB after 3 6 months. In contrast, the high rejection group (10 patients) had a si gnificantly higher ongoing rejection rate (p less than or equal to 0.0 4 to p less than or equal to 0.001) throughout their postoperative cou rse up to 72 months. Conclusions. The majority of our transplant patie nts demonstrate a decrease in rejection with time and do not require R SEMB beyond 30 months. We identified a group of patients who exhibited a higher rate of rejection and need continued RSEMB.