Use of Endomyocardial Biopsy in Long-Term Follow-up of Patients after Pediatric Heart Transplantation: A Monocentric Experience

Objectives: Although immunosuppressive therapy has significantly improved and acute rejection is less frequent, endomyocardial biopsy (EMB) remains an important tool in long-term care of pediatric and adult patients after pediatric heart transplantation (HTX). This study is to report our experience with such patients and to discuss the use of EMB for long-term follow-up in a patient focused setting.

Methods: A total of 251 consecutive EMBs in 122 patients have been analyzed. We especially focused on indication for EMB, procedure related complications, Results of histological analyses and their impact on the therapeutic course.

Results: Main indication for EMB less than 12 months after HTX (n = 53) was diagnosis of therapeutically relevant acute cellular and humoral rejection (positive in 12/53 cases). During long-term follow-up more than 12 months after HTX routine EMB was mainly performed, including coronary angiography (174/198 EMB), for monitoring of chronic graft failure, coronary vasculopathy (induction of statin therapy due to histological/angiographical Results in 7.6%) and therapeutically relevant asymptomatic late acute cellular rejection (2.3%). Severe adverse events occurred in 1.2%, mild adverse events in 14.3%. Chronic occlusion of the peripheral venous access site was seen in 12.0% and of the peripheral arterial access site in 15.1%.

Conclusion: EMB remains and important tool in long-term follow-up of patients after pediatric HTX. The best use is obtained using an individual approach, considering patient based indication, risk factors, long-term complications and the expected benefit of the histological analysis.