Is it necessary to perform surveillance endomyocardial biopsies in heart transplant recipients?

Abstract

Background: Routine surveillance endomyocardial biopsies to diagnose unsuspected rejection are performed at 3- to 12-month intervals after heart transplantation. From 1979 to 1989, surveillance biopsies were routinely performed as a part of the yearly evaluation.

Methods: A retrospective analysis of the follow-up data showed that "routine surveillance biopsies" had an extremely low yield, and, on the basis of the results of this study, we discontinued to perform surveillance biopsies beyond 6 months after transplantation. To validate these results, we compared the outcome of two groups of patients who had similar demographics and identical immunosuppression, except that in one group the surveillance biopsies were not performed.

Results: No difference was found in either actuarial survival rate or freedom from late rejection between the two groups.

Conclusions: These findings confirm that routine surveillance heart biopsies beyond 6 months after transplantation are not necessary and they should be performed only if there is clinical suspicion of rejection or as part of a research protocol.