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Outcomes of low-intensity biopsy surveillance for rejection in paediatric cardiac transplantation

Published online by Cambridge University Press:  17 June 2019

Patrick D. Evers Open the ORCID record for Patrick D. Evers [Opens in a new window] ,
Neal Jorgensen ,
Borah Hong ,
Erin Albers ,
Mariska Kemna ,
Josh Friedland-Little ,
Robert J. Boucek  and
Yuk Law
Patrick D. Evers
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Neal Jorgensen
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA
Borah Hong
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA
Erin Albers
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA
Mariska Kemna
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA
Josh Friedland-Little
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA
Robert J. Boucek
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA
Yuk Law*
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA
*
Author for correspondence: Yuk Law, MD, Division of Cardiology, Seattle Children’s Hospital, M/S RC.2.820, PO Box 5371, Seattle, WA 98105, USA. Tel: 206-987-1417; Fax: 206-987-3839. E-mail: yuk.law@seattlechildrens.org
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Abstract

Background:

Significant inter-centre variability in the intensity of endomyocardial biopsy surveillance for rejection following paediatric cardiac transplantation has been reported. Our aim was to determine if low-intensity biopsy surveillance with two scheduled biopsies in the first year would produce outcomes similar to published registry outcomes.

Methods:

A retrospective study of paediatric recipients transplanted between 2008 and 2014 using a low-intensity biopsy protocol consisting of two surveillance biopsies at 3 and 12–13 months in the first post-transplant year, then annually thereafter. Additional biopsies were performed based on echocardiographic and clinical surveillance. Excluded were recipients that were re-transplanted or multi-organ transplanted or were followed at another institution.

Results:

A total of 81 recipients in the first 13 months after transplant underwent an average of 2 (SD ± 1.3) biopsies, 24 ± 6.8 echocardiograms, and 17 ± 4.4 clinic visits per recipient. During the 13-month period, 19 recipients had 24 treated rejection episodes, with the first at an average of 2.8 months post-transplant. The 3-, 12-, 36-, and 60-month conditional on discharge graft survival were 100%, 98.8%, 98.8%, and 90.4%, respectively, comparable to reported figures in major paediatric registries. At a mean follow-up of 4.7 ± 2.1 years, four patients (4.9%) developed cardiac allograft vasculopathy, three (3.7%) developed a malignancy, and seven (8.6%) suffered graft loss.

Conclusion:

Rejection surveillance with a low-intensity biopsy protocol demonstrated similar intermediate-term outcomes and safety measures as international registries up to 5 years post-transplant.

Keywords

Organ transplantationechocardiographypaediatrics
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 7 , July 2019 , pp. 910 - 916
Copyright
© Cambridge University Press 2019 

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