Routine surveillance endomyocardial biopsy continues to detect significantrejection late after heart transplantation

Background: The need for continued surveillance endomyocardial biopsies bey ond the first year after cardiac transplantation is controversial. We evalu ated the incidence of rejections requiring treatment (International Society Heart and Lung Transplantation grade 3A or greater) in patients 5 years or more after heart transplantation. Methods: We conducted a retrospective chart review of all patients who unde rwent at least 1 endomyocardial biopsy at our center 5 years or more after heart transplantation. Results: A total of 461 biopsies were performed in 77 patients 5 or more ye ars after heart transplantation. Nine episodes of grade 3A or greater rejec tion were identified in 8 of 77 patients (10%). During the first year, 7.6% of biopsies were grade 3A or greater. Grade 3A rejection occurred in appro ximately 3.5% to 4% of biopsies during years 2 to 7. The overall incidence of procedural related complications at our institution was < 0.5%. Conclusion: Endomyocardial biopsies continue to detect clinically significa nt rejection beyond 5 years after cardiac transplantation. The overall inci dence of procedural related complications requiring treatment was low and n one was life threatening. The absence of early rejection does not predict f reedom from late rejection. Therefore, we continue to recommend surveillanc e biopsies in cardiac transplant recipients late after transplantation.