Chi N-H, Chou N-K, Tsao C-I, Huang S-C, Wu I-H, Yu H-Y, Chen Y-S, Wang S-S
Department of Cardiothoracic Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Transplant Proc. 2012 May;44(4):894-6. doi: 10.1016/j.transproceed.2012.02.010.
Endomyocardial biopsy is the gold standard to identify rejection after heart transplantation. Due to its invasiveness, discomfort, and difficult vascular access, some patients are not willing to accept routine scheduled biopsies years after heart transplantation. The purpose of this study was to identify whether there was a difference in outcomes among the scheduled versus event biopsy groups.
We studied 411 patients who underwent heart transplantation from 1987 to 2011, reviewing biopsy results and pathology reports. There were 363 patients who followed the scheduled biopsy protocol, and 48 patients who were assigned to the event biopsy group. We extracted data on biopsy results, rejection episodes, rejection types, and survival time.
The 2481 reviewed biopsies over 24 years, showed most rejection episodes (86.4%) to occur within 2 years after heart transplantation. The rejection incidence was low (2.1%) at 3 years after transplantation. The major reason for an event biopsy was poor vascular access, such as tiny central vein or congenital disease without a suitable central vein. Event biopsy group patients were younger than schedule biopsy patients (19.7 years old vs 47.6 years old; P < .05). The 10-year survival rates were 64% among the event versus 53% among the scheduled biopsy group (P = .029). The 10-year rates of freedom from rejection were similar.
The rejection rate was low after 3 years; episodes occurred within 2 years. Although the long-term survival in the event group was better, they had a younger man age. The rejection and freedom from rejection rates were similar. As the rejection rate was low at 3 years after transplantation, we suggest that the event principle could be applied for biopsy at 3 years after heart transplantation.
心内膜心肌活检是心脏移植后识别排斥反应的金标准。由于其具有侵入性、会给患者带来不适且血管通路建立困难，一些患者在心脏移植数年之后不愿接受常规的定期活检。本研究的目的是确定定期活检组与事件活检组在结局方面是否存在差异。
我们研究了1987年至2011年间接受心脏移植的411例患者，回顾了活检结果和病理报告。有363例患者遵循定期活检方案，48例患者被分配到事件活检组。我们提取了关于活检结果、排斥反应发作、排斥反应类型和生存时间的数据。
在24年期间共审查了2481次活检，结果显示大多数排斥反应发作（86.4%）发生在心脏移植后的2年内。移植后3年时排斥反应发生率较低（2.1%）。进行事件活检的主要原因是血管通路不佳，如中心静脉细小或患有先天性疾病而没有合适的中心静脉。事件活检组患者比定期活检组患者年轻（19.7岁对47.6岁；P <.05）。事件活检组的10年生存率为64%，而定期活检组为53%（P = 0.029）。10年无排斥反应率相似。
3年后排斥反应率较低；发作发生在2年内。尽管事件活检组的长期生存率较好，但患者年龄较轻。排斥反应和无排斥反应率相似。由于移植后3年时排斥反应率较低，我们建议心脏移植后3年可采用事件原则进行活检。
