STRATEGIES FOR ROUTINE BIOPSIES IN HEART-TRANSPLANTATION BASED ON 8-YEAR RESULTS WITH MORE THAN 13,000 BIOPSIES

被引：8

作者：

HAUSEN, B

ROHDE, R

DEMERTZIS, S

ALBES, JM

WAHLERS, T

SCHAFERS, HJ

机构：

[1] Division of Thoracic and Cardmvascular Surgery, Surgical Center, Hannover Medical School, Hannover, D-30623

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1995年 / 9卷 / 10期

关键词：

HEART TRANSPLANTATION; ENDOMYOCARDIAL BIOPSIES; BIOPSY STATISTICS AND NUMERICAL DATA; HEART TRANSPLANTATION STANDARDS; IMMUNOSUPPRESSIVE AGENTS THERAPEUTIC USE;

D O I：

10.1016/S1010-7940(05)80012-0

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The endomyocardial biopsy (EMB) in heart transplant recipients has been considered the ''gold standard'' for diagnosis of graft rejection (REJ). The purpose of this retrospective study is to develop long-term strategies (frequency and postoperative duration of EMB) for REJ monitoring. Between 1985 and 1992, 346 patients (mean age 44.5 years, female patients = 14%) received 382 heart grafts. For graft surveillance EMBs were performed according to a fixed schedule depending on postoperative day and the results of previous biopsies. In the first year the average number (no.) of EMBs/patient was 20 with 19% positive for REJ in the first quarter, dropping to 7% REJ/EMB by the end of the first year. The percentage of REJ/EMB;IB declined annually from 4.7% to 4.5%, 2.2% and less than 1% after the fifth year, Individual biopsy results in the first 3 postoperative months had little predictive value. Patients with fewer than two REJ (group 1), vs patients with two or more REJ in the first 6 postoperative months (group 2), were significantly less likely to reject in the second half of the first year (group 1: 0.29 +/- 0.6 REJ/patient; group 2: 0.83 +/- 1.3 REJ/patient; P < 0.001) and third postoperative year (group 1: 0.12 +/- 0.33 REJ/patients; group 2: 0.46 +/- 0.93 REJ/patient; P < 0.05). In conclusion, routine EMBs in the first 3 postoperative months have only limited predictive value, however the number of routine EMBs can be drastically reduced later depending on the intermediate postoperative REJ pattern.

引用

页码：592 / 598

页数：7

共 15 条

[1]

Bhat G., Burwig S., Walsh R., Morbidity of endomyocardial biopsy in cardiac transplant recipients, Am Heart J, 125, pp. 1180-1181, (1993)

[2]

Caves P.K., Stinsonl B., Billingham M.E., Grehl T.M., Shumway N.E., Percutaneous transvenous endomyocardial biopsy, JAMA, 225, pp. 288-291, (1973)

[3]

Gibbons R.S., Doppler echocardiography for rejection surveillance in the cardiac allograft recipient, J am Soc Echocar-Diogr, 4, pp. 97-104, (1991)

[4]

Hammer C., Klanke D., Lersch C., Dirschedl P., Kemkes B.M., Gokel M., Reichenspurner H., Reichart B., Cytoimmuno-logic monitoring (CIM) for differentiation between cardiac rejection and viral, bacterial, or fungal infection: Its specificity and sensitivity, Transplant Proc, 21, pp. 3631-3633, (1989)

[5]

Henzlova M.J., Nath H., Bucy R.P., Bourge R.C., Kirklin J.K., Rogers W.J., Coronary artery to right ventricle fistula in heart transplant recipients: A complication of endomyocardial biopsy, J am Coll Cardiol, 14, pp. 258-261, (1989)

[6]

Huddleston C.B., Rosenbloom M., Goldstein J.A., Pasque M.K., Biopsy-induced tricuspid regurgitation after cardiac transplantation, Ann Thorac Surg, 57, pp. 832-836, (1994)

[7]

Kemkes B.M., Schutz A., Engelhardt M., Brandi U., Breuer B., Noninvasive methods of rejection diagnosis after heart transplantation, J Heart Lung Transplant, 11, pp. 221-231, (1992)

[8]

Kemnitz J., Cohnert T., Schaefers H.J., Helmke M., Wahlers T., Herrmann G., Schmidt R.M., Haverich A., A classification of cardiac allograft rejection. A modification of the classification by Billmgham, Am J Pathol, 11, pp. 503-515, (1987)

[9]

Kottke Marchant K., Ratliff N.B., Endomyocardial biopsy. Pathologic findings in cardiac transplant recipients, Pathol An-Nu, 25, pp. 211-244, (1990)

[10]

Muller J., Warnecke H., Spiegelsberger S., Hummel M., Cohnert T., Hetzer R., Reliable nonmvasive rejection diagnosis after heart transplantation m childhood, J Heart Lung Transplant, 12, pp. 189-198, (1993)

← 1 2 →