Ann Thorac Surg 1997;64:1236
© 1997 The Society of Thoracic Surgeons
Discussion
Discussion
See also page 1231.
DR JACK J. CURTIS (Columbia, MO): I greatly enjoyed this paper and was excited to see it on the program. At the University of Missouri we have followed a similar but slightly different trend. We stop performing biopsies in patients who have not had any rejection by 2 years, and that is about 50% of our patients. I wonder if you have analyzed your groups that way, the nonrejectors, to see what your outcome was. And also, there are those people who have pesky rejections during the first year or 2 but then go 2 years without having a subsequent rejection. We also stop doing biopsies in those people. I am wondering if we might be missing something based on your data as you have presented it. I enjoyed your paper.
DR HEIMANSOHN: Thank you, Dr Curtis, for your kind comments. Within our study population of 80 patients, 10 patients never exhibited a myocardial rejection episode. These patients would fall into the low-rejection group, and our cutoff of 2.5 years would go along with your finding. We would certainly consider the patients who have had a lot of episodes of rejection in the first year to be in the higher risk group, although we would then evaluate them at 2.5 years.
DR JAMES K. KIRKLIN (Birmingham, AL): Could you be more specific about your current protocol for discontinuation of biopsies?
Second, all of us have had the experience of occasional tragic patients who go years without a rejection episode and then come in with profound low cardiac output to die of acute rejection. Do you believe there is any role for substituting, let us say, at 2 years in that low-rejection group some surveillance echocardiographic assessment periodically so that you might get a clue of diminished ventricular function perhaps weeks before the fatal event?
DR HEIMANSOHN: Although patients do not receive routine surveillance endomyocardial biopsies after 30 months, all patients do present to a transplant patient clinic every 3 months postoperatively and are seen by a transplant cardiologist at those clinics. Diagnostics for each clinic include a chest roentgenogram, blood chemistry profile, and complete blood count with differential. In addition, each patient undergoes an annual angiogram, echocardiogram, and ejection fraction determination.
Related Article
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Routine Surveillance Endomyocardial Biopsy: Late Rejection After Heart Transplantation
- David A. Heimansohn, Robert J. Robison, John M. Paris, III, Robert G. Matheny, JoAnne Bogdon, and Carl J. Shaar
Ann. Thorac. Surg. 1997 64: 1231-1236.
[Abstract]
[Full Text]
