Cardiac allograft rejection.
ABSTRACT Success in cardiac transplantation has been achieved by the development of improved immunosuppressive therapies, which have led to a concomitant decrease in cardiac allograft rejection and infection. Rejection however continues to be the cause of significant morbidity and mortality particularly in the first year after cardiac transplantation. The endomyocardial biopsy remains an essential tool for its diagnosis. Acute cellular rejection has been a well recognized phenomenon although more recently, the diagnosis of antibody-mediated rejection has gained acceptance, a condition associated with greater graft dysfunction, subsequent development of cardiac allograft vasculopathy and mortality. In this article we review the current status of the diagnosis of cardiac allograft rejection as determined by the traditional endomyocardial biopsy, the more recent advances in the non-invasive evaluation of rejection, detection of circulating antibodies and the treatment of rejection.
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ABSTRACT: Heart transplantation (HTX) has become an established therapy for patients with end-stage heart failure. Endomyocardial biopsy (EMB) still represents the gold standard for routine surveillance of heart transplant rejection. The objective of this article is to report our experience regarding the use of EMB in monitoring heart transplant recipients. We evaluated retrospectively all patients who underwent orthotopic HTX between 2000 and 2011 at our hospital. From all patients, we created a follow-up, determined the number of EMB events and described the complications associated with this procedure. HTX was performed in 142 cases at our center in the last 11 years (1.3% of the total of 10693 cardiac surgical operations in that period). Further 9 patients visited our department for monitoring after HTX performed at an external center (total: 151). For all patients, a total of 1896 EMB events have been recorded. The majority of biopsies were performed through the right internal jugular vein. The overall complication rate was 1% (n=19). The histological examination of right ventricular EMB still represents the gold standard of care for cardiac allograft rejection monitoring. EMB is an invasive, but safe and dedicated diagnostic procedure. However, the usefulness of recent non-invasive diagnostic approaches as an adjunct tool in monitoring for rejection remains to be further analyzed.International journal of clinical and experimental pathology 01/2013; 6(1):55-65. · 2.24 Impact Factor