THE CHALLENGE OF ENDOMYOCARDIAL BIOPSY INTERPRETATION IN ASSESSING CARDIAC ALLOGRAFT-REJECTION

The endomyocardial biopsy has long been the preferred technique for mo nitoring the rejection status of the cardiac allograft. During the pas t year, published reports have addressed important issues concerning t he endomyocardial biopsy, including the reliability of the internation al Society for Heart and Lung Transplantation grading system; problem areas in posttransplantation biopsy interpretation, including grade 2 rejection and myocyte injury, Quilty lesions, and ischemic injury; the natural history of grade 2 rejection; the necessity of surveillance b iopsies late in the posttransplantation course; and the efficacy of nu merous noninvasive techniques in diagnosing or predicting rejection. N o technique developed to date has been shown to have the sensitivity o r specificity needed to replace the endomyocardial biopsy as a diagnos tic tool. In addition, studies of endomyocardial biopsy specimens have furthered our understanding of the pathobiology of rejection and othe r transplant-related conditions.