Safety and utility of the routine surveillance biopsy in pediatric patients 2 years after heart transplantation
Safety and utility of the routine surveillance biopsy in pediatric patients 2 years after heart transplantation
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DOI：
10.1016/s0022-3476(00)70108-9
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发表时间：
2000-02-01
影响因子：
5.1
通讯作者：
Bernstein, D
中科院分区：
文献类型：
--
作者：
Chin, C;Akhtar, MJ;Bernstein, D
目的：诊断心脏移植术后同种异体移植排斥反应的标准是心内膜心肌活检，但移植后2年常规监测活检的价值存在争议。本研究的目的是确定监测活检的必要性和安全性，并将排斥反应与儿科患者移植后两周后的体征和症状联系起来。研究设计：我们回顾了 56 名儿科患者的 899 例活检结果和一致的临床病史，包括 314 患者年的随访。根据对临床状态和超声心动图的盲法审查，将患者分为有症状或无症状。根据既定标准将活检分为阴性或阳性。结果：排除移植后 2 年内进行的活检或作为阳性活检的后续活检后，481 个活检可供分析，其中 20 个（4%）呈阳性。在 456 例无症状患者活检中，有 15 例 (3%) 发现阳性活检，而在 25 例有症状患者活检中，只有 5 例 (20%) 呈阳性。有症状的患者活检呈阳性的可能性是无症状患者的 6 倍。在阳性排斥反应中，75% 发生在没有症状的患者中。结论：虽然移植后 2 年以上的儿科患者中排斥反应并不常见，但可治疗的同种异体移植排斥反应可能会在没有临床体征和症状的情况下发生。这项研究强调了即使在移植后第二年，对没有症状的患者继续进行常规监测活检的安全性和必要性。
Objectives: The standard for diagnosing allograft rejection after heart transplantation is the endomyocardial biopsy, but the value of routine surveillance biopsies after 2 years after transplant is controversial. The objective of this study was to determine the necessity and safety of surveillance biopsies and to correlate rejection with signs and symptoms beyond the second post-transplant anniversary in pediatric patients.Study design: We reviewed the results of 899 biopsies and coincident clinical histories in 56 pediatric patients, comprising 314 patient-years of followup. Patients were classified as having symptoms or not based on a blinded review of their clinical status and echocardiograms. Biopsies were classified as negative or positive with established criteria.Results: After biopsies performed less than 2 years after transplant or as a follow-up for a positive biopsy were excluded, 481 biopsies were available for analysis, of which 20 (4%) were positive. Positive biopsies were found in 15 (3%) of 456 biopsies in patients without symptoms compared with 5 (20%) of 25 biopsies in patients with symptoms. Patients with symptoms were 6 times more likely to have a positive biopsy compared with patients without symptoms. Of the positive rejection episodes, 75% occurred in patients without symptoms.Conclusion: Although rejection is uncommon in pediatric patients greater than 2 years after transplant, episodes of treatable allograft rejection can occur in the absence of clinical signs and symptoms. This study emphasizes the safety of and the need to continue to perform routine surveillance biopsies in patients without symptoms, even after the second post-transplant year.