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Lower frequency routine surveillance endomyocardial biopsies after heart transplantation

In heart transplantation (HTx) patients, routine surveillance endomyocardial biopsies (rsEMB) are recommended for the detection of early cardiac allograft rejection. However, there is no consensus on the optimal frequency of rsEMB. Frequent rsEMB have shown a low diagnostic yield in the new era of p...

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Autores principales: Weckbach, Ludwig T., Maurer, Ulrich, Schramm, Rene, Huber, Bruno C., Lackermair, Korbinian, Weiss, Max, Meiser, Bruno, Hagl, Christian, Massberg, Steffen, Eifert, Sandra, Grabmaier, Ulrich
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571958/
https://www.ncbi.nlm.nih.gov/pubmed/28841655
http://dx.doi.org/10.1371/journal.pone.0182880
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author Weckbach, Ludwig T.
Maurer, Ulrich
Schramm, Rene
Huber, Bruno C.
Lackermair, Korbinian
Weiss, Max
Meiser, Bruno
Hagl, Christian
Massberg, Steffen
Eifert, Sandra
Grabmaier, Ulrich
author_facet Weckbach, Ludwig T.
Maurer, Ulrich
Schramm, Rene
Huber, Bruno C.
Lackermair, Korbinian
Weiss, Max
Meiser, Bruno
Hagl, Christian
Massberg, Steffen
Eifert, Sandra
Grabmaier, Ulrich
author_sort Weckbach, Ludwig T.
collection PubMed
description In heart transplantation (HTx) patients, routine surveillance endomyocardial biopsies (rsEMB) are recommended for the detection of early cardiac allograft rejection. However, there is no consensus on the optimal frequency of rsEMB. Frequent rsEMB have shown a low diagnostic yield in the new era of potent immunosuppressive regimen. Efficacy and safety of lower frequency rsEMB have not been investigated so far. In this retrospective, single centre, observational study we evaluated 282 patients transplanted between 2004 and 2014. 218 of these patients were investigated by rsEMB and symptom-triggered EMB (stEMB). We evaluated EMB results, complications, risk factors for rejection, survival 1 and 5 years as well as incidence of cardiac allograft vasculopathy (CAV) 3 years after HTx. A mean of 7.1 ± 2.5 rsEMB were conducted per patient within the first year after HTx identifying 7 patients with asymptomatic and 9 patients with symptomatic acute rejection requiring glucocorticoide pulse therapy. Despite this relatively low frequency of rsEMB, only 6 unscheduled stEMB were required in the first year after HTx leading to 2 additional treatments. In 6 deaths among all 282 patients (2.1%), acute rejection could not be ruled out as a potential underlying cause. Overall survival at 1 year was 78.7% and 5-year survival was 74%. Incidence of CAV was 17% at 3-year follow-up. Morbidity and mortality of lower frequency rsEMB are comparable with data from the International Society for Heart and Lung Transplantation (ISHLT) registry. Consensus is needed on the optimal frequency of EMB.
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spelling pubmed-55719582017-09-09 Lower frequency routine surveillance endomyocardial biopsies after heart transplantation Weckbach, Ludwig T. Maurer, Ulrich Schramm, Rene Huber, Bruno C. Lackermair, Korbinian Weiss, Max Meiser, Bruno Hagl, Christian Massberg, Steffen Eifert, Sandra Grabmaier, Ulrich PLoS One Research Article In heart transplantation (HTx) patients, routine surveillance endomyocardial biopsies (rsEMB) are recommended for the detection of early cardiac allograft rejection. However, there is no consensus on the optimal frequency of rsEMB. Frequent rsEMB have shown a low diagnostic yield in the new era of potent immunosuppressive regimen. Efficacy and safety of lower frequency rsEMB have not been investigated so far. In this retrospective, single centre, observational study we evaluated 282 patients transplanted between 2004 and 2014. 218 of these patients were investigated by rsEMB and symptom-triggered EMB (stEMB). We evaluated EMB results, complications, risk factors for rejection, survival 1 and 5 years as well as incidence of cardiac allograft vasculopathy (CAV) 3 years after HTx. A mean of 7.1 ± 2.5 rsEMB were conducted per patient within the first year after HTx identifying 7 patients with asymptomatic and 9 patients with symptomatic acute rejection requiring glucocorticoide pulse therapy. Despite this relatively low frequency of rsEMB, only 6 unscheduled stEMB were required in the first year after HTx leading to 2 additional treatments. In 6 deaths among all 282 patients (2.1%), acute rejection could not be ruled out as a potential underlying cause. Overall survival at 1 year was 78.7% and 5-year survival was 74%. Incidence of CAV was 17% at 3-year follow-up. Morbidity and mortality of lower frequency rsEMB are comparable with data from the International Society for Heart and Lung Transplantation (ISHLT) registry. Consensus is needed on the optimal frequency of EMB. Public Library of Science 2017-08-25 /pmc/articles/PMC5571958/ /pubmed/28841655 http://dx.doi.org/10.1371/journal.pone.0182880 Text en © 2017 Weckbach et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Weckbach, Ludwig T.
Maurer, Ulrich
Schramm, Rene
Huber, Bruno C.
Lackermair, Korbinian
Weiss, Max
Meiser, Bruno
Hagl, Christian
Massberg, Steffen
Eifert, Sandra
Grabmaier, Ulrich
Lower frequency routine surveillance endomyocardial biopsies after heart transplantation
title Lower frequency routine surveillance endomyocardial biopsies after heart transplantation
title_full Lower frequency routine surveillance endomyocardial biopsies after heart transplantation
title_fullStr Lower frequency routine surveillance endomyocardial biopsies after heart transplantation
title_full_unstemmed Lower frequency routine surveillance endomyocardial biopsies after heart transplantation
title_short Lower frequency routine surveillance endomyocardial biopsies after heart transplantation
title_sort lower frequency routine surveillance endomyocardial biopsies after heart transplantation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571958/
https://www.ncbi.nlm.nih.gov/pubmed/28841655
http://dx.doi.org/10.1371/journal.pone.0182880
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