title: Routine surveillance endomyocardial biopsy continues to detect significant rejection late after heart transplantation.
abstract: BACKGROUND
  The need for continued surveillance endomyocardial biopsies beyond the first year after cardiac transplantation is controversial. We evaluated 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 underwent 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 years after heart transplantation. Nine episodes of grade 3A or greater rejection 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 approximately 3.5% to 4% of biopsies during years 2 to 7. The overall incidence of procedural related complications at our institution was < 0.5%.
  
  
  CONCLUSIONS
  Endomyocardial biopsies continue to detect clinically significant rejection beyond 5 years after cardiac transplantation. The overall incidence of procedural related complications requiring treatment was low and none was life threatening. The absence of early rejection does not predict freedom from late rejection. Therefore, we continue to recommend surveillance biopsies in cardiac transplant recipients late after transplantation.
authors.affiliation: Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: W Q
authors.initials: WQ
authors.lastname: Gradek
authors.forename: C
authors.initials: C
authors.lastname: D'Amico
authors.forename: A L
authors.initials: AL
authors.lastname: Smith
authors.forename: D
authors.initials: D
authors.lastname: Vega
authors.forename: W M
authors.initials: WM
authors.lastname: Book
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D003955:Diagnostic Tests, Routine / Q000379:methods*; D004452:Echocardiography / Q000009:adverse effects; D004699:Endocardium / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000401:mortality; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D013997:Time Factors