title: Variation in the use of surveillance endomyocardial biopsy among pediatric heart transplant centers over time.
abstract: EMB is widely utilized for graft surveillance after HTx; however, there is significant variation in the frequency of surveillance EMB use during the first year post-HTx. The aim of this study was to assess changes in the utilization of surveillance EMB over time among member institutions of PHTS. A survey of PHTS centers assessing the frequency of surveillance EMB use during the first year post-HTx was conducted in 2006. The same survey was repeated in 2014 to assess changes in practice over time. The number of EMB in infants ranged from 0 to 9 and in adolescents 0 to 16. The number of EMB decreased or remained unchanged in the majority of centers. Fewer EMB are performed in infants compared to adolescents and this practice did not change over time. There was a significant decrease in surveillance EMB use in adolescents (p = 0.012). International centers perform significantly fewer EMB in adolescents when compared to centers within the United States (p = 0.006). There continues to be significant variation in the utilization of surveillance EMB, with a shift toward less reliance on EMB for adolescents in the current era. Further research is necessary to determine the optimal frequency of invasive monitoring that reduces costs without compromising outcomes.
authors.affiliation: Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Godown
authors.affiliation: Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Harris
authors.affiliation: Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Burger
authors.affiliation: Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Dodd
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000706:statistics & numerical data / Q000639:trends; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004699:Endocardium / Q000473:pathology*; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000473:pathology*; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data / Q000639:trends*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009206:Myocardium / Q000473:pathology*; D011182:Postoperative Care / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States
keywords: endomyocardial biopsy; heart transplantation; pediatric; rejection