Key result
Tacrolimus-based immunosuppression was associated with significantly less rejection on surveillance endomyocardial biopsy in the first year post-transplantation compared to cyclosporin A (14% vs 24%, p=0.035).
Why the study?
What is the diagnostic yield of endomyocardial biopsy for rejection surveillance in pediatric heart transplant recipients?
Cohort (n=82)
What is the diagnostic yield of endomyocardial biopsy for rejection surveillance in pediatric heart transplant recipients?
Absolute Event Rate: 14% vs 24%
p-value: p=0.035
Surveillance endomyocardial biopsy remains an important diagnostic tool for detecting rejection during the first 5 years after pediatric heart transplantation, particularly after reducing immunosuppression.
May support tacrolimus over cyclosporin A to lower year-1 biopsy-detected rejection after pediatric transplant; leaves open regimen-specific surveillance protocols.
The objective of this study was to define the diagnostic yield for endomyocardial biopsy (EMB) procedures performed for various indications in a large pediatric heart transplant population. Endomyocardial biopsy procedure has been employed as the 'gold standard' for rejection surveillance. Previous studies have questioned the value of surveillance EMB beyond the early post-transplant period. We retrospectively reviewed data on 82 pediatric heart transplant recipients with serial EMB. A total of 1,169 EMB were performed during a follow-up period of 2-149 months (median 41 months). EMB were classified by age at transplantation, time from transplant, immunosuppressive regimen used [tacrolimus vs. cyclosporin A (CsA)] and indication, i.e. surveillance, follow-up after rejection or lowering of immunosuppression, non-specific clinical symptoms and graft dysfunction. During the first year after heart transplantation, surveillance EMB demonstrated significant rejection [International Society for Heart and Lung Transplantation (ISHLT) grade > or = 3A] in 18% of biopsies with the yield being 14-43% for all other indications. Surveillance EMB 1-5 yr post-transplantation were found to have a lower diagnostic yield in infants (4%, vs. 13% in children) and in patients with favorable first-year rejection history (9% vs. 17% in 'frequent rejectors'). Tacrolimus-based immunosuppression was associated with significantly less rejection, but only in the first year post-transplantation (14% in tacrolimus vs. 24% in CsA surveillance EMB, p = 0.035). Surveillance EMB remains an important diagnostic tool for rejection surveillance during the first 5 years after pediatric heart transplantation. Endomyocardial biopsy is particularly warranted after reduction of immunosuppression and for monitoring for ongoing rejection after treatment of acute rejection episodes.
No takes yet. Share an insight, caveat, or question.
Wagner et al. (2000) conducted a cohort in Pediatric heart transplant (n=82). Tacrolimus-based immunosuppression vs. Cyclosporin A (CsA) was evaluated on Significant rejection (ISHLT grade ≥ 3A) on surveillance endomyocardial biopsy in the first year post-transplantation (p=0.035). Tacrolimus-based immunosuppression was associated with significantly less rejection on surveillance endomyocardial biopsy in the first year post-transplantation compared to cyclosporin A (14% vs 24%, p=0.035).
Synapse has enriched 2 closely related papers on similar clinical questions. Consider them for comparative context: