心脏移植术后一年以上，常规监测性心肌活检并无必要。

Routine surveillance myocardial biopsies are unnecessary beyond one year after heart transplantation.

作者信息

White J A, Guiraudon C, Pflugfelder P W, Kostuk W J

机构信息

Department of Medicine (Cardiology), University Hospital, University of Western Ontario, London, Canada.

出版信息

J Heart Lung Transplant. 1995 Nov-Dec;14(6 Pt 1):1052-6.

PMID:8719450

Abstract

BACKGROUND

Myocardial rejection is most apt to occur in the first 90 days after heart transplantation. Nevertheless, surveillance endomyocardial biopsies are often performed on a regular basis, indefinitely. The benefit of this approach to patient management is uncertain. Our objective was to determine the frequency of abnormalities and the influence of a routine annual endomyocardial biopsy on patient management.

METHODS

In a consecutive series of 235 transplant recipients who survived 1 year or more, the results of 1123 routine endomyocardial biopsies performed 1 year or more after transplantation were reviewed. The incidence of late rejection, presence of Quilty effect (focal endocardial or myocardial lymphocytic aggregates), and therapeutic reaction to the biopsy result were analyzed.

RESULTS

Of 1123 biopsy specimens in 235 patients (1 to 12 years after transplantation), 1115 (99.3%) showed no evidence of significant rejection (grade 0 or 1). Only seven (0.6%) had evidence of rejection grade 2 or worse. Of the seven abnormal biopsy specimens in seven patients, two occurred at 1 year, two at 2 years, and one each at 4, 7, and 8 years. Of these, six were treated for rejection with an increase in the immunosuppressive therapy. One patient was identified as having a symptomatic condition at the time of biopsy. A focal endocardial or myocardial accumulation of lymphocytes (Quilty effect) was present in 311 biopsy specimens (27.6%). Beyond 1 year, 33 patients died, 14 because of graft vascular disease with or without rejection and 19 because of other causes. No deaths were predicted on the basis of a routine surveillance biopsy.

CONCLUSIONS

Myocardial rejection is rare beyond 1 year after transplantation. The routine endomyocardial biopsy does not significantly impact patient management beyond 1 year. A selective approach to myocardial biopsies, on the basis of a change in clinical status or immunosuppressive medications, is justified.

摘要

背景

心脏移植后最初90天内心肌排斥反应最易发生。然而，监测性心内膜心肌活检通常会定期、无限期地进行。这种方法对患者管理的益处尚不确定。我们的目的是确定异常情况的发生率以及常规年度心内膜心肌活检对患者管理的影响。

方法

回顾了连续235例存活1年或更长时间的移植受者在移植1年或更长时间后进行的1123次常规心内膜心肌活检结果。分析了晚期排斥反应的发生率、奎尔蒂效应（局灶性心内膜或心肌淋巴细胞聚集）的存在情况以及对活检结果的治疗反应。

结果

在235例患者（移植后1至12年）的1123份活检标本中，1115份（99.3%）未显示明显排斥反应（0级或1级）证据。只有7份（0.6%）有2级或更严重排斥反应的证据。在7例患者的7份异常活检标本中，2例发生在1年时，2例发生在2年时，4年、7年和8年时各有1例。其中，6例因排斥反应接受了免疫抑制治疗增加的处理。1例患者在活检时被确定有症状性疾病。311份活检标本（27.6%）存在局灶性心内膜或心肌淋巴细胞聚集（奎尔蒂效应）。1年后，33例患者死亡，14例死于有或无排斥反应的移植血管疾病，19例死于其他原因。没有根据常规监测活检预测到死亡病例。