The yield of surveillance endomyocardial biopsies as a screen for cellular rejection in pediatric heart transplant patients
The yield of surveillance endomyocardial biopsies as a screen for cellular rejection in pediatric heart transplant patients
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DOI：
10.1046/j.1397-3142.2003.00115.x
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发表时间：
2004-02-01
影响因子：
1.3
通讯作者：
Wetzel, GT
中科院分区：
文献类型：
--
作者：
Levi, DS;DeConde, AS;Wetzel, GT
肌内膜活检通常用于筛查小儿心脏移植患者的细胞排斥反应。在儿科心脏移植患者中，当结合新开发的免疫组织化学技术和现代免疫抑制剂时，EMB的产量尚不清楚。OHT后，对所有儿科患者进行常规监测活检。EMB也对怀疑有排斥反应的症状性OHT患者进行。所有阳性结果（大于ISH LT 113级）均经免疫组化染色证实。对1995年1月至2003年1月在该机构进行的连续EMB进行了回顾性分析。每次活检时的超声心动图结果、临床病史和治疗变化也被分类。在回顾的136例儿童心脏移植移植物（127例患者，64例男性）的1093例EMB结果中，825例活检是对他克莫司治疗的患者进行的，268例是对环孢素治疗的患者进行的。用他克莫司治疗的患者的显著排斥反应（大于ISHLT 1B级排斥反应）的发生率为0.85%（7/825），而用环孢霉素治疗的患者的发生率为4.1%（11/268）（p < 0.0005）。在无症状的他克莫司患者中，只有两个筛选活检（0.26%）表现出明显的排斥反应，这两个都是在移植后第一个月内进行的。在有症状的他克莫司患者中，9.1%（n = 5）的活检结果与显著的细胞排斥反应一致。1B级排斥反应25例。其中22名患者未接受治疗，所有I级B排斥反应病例均消退，无临床后遗症。对于OHT EMB后超过30天的儿科患者，未能显示他克莫司治疗的无症状患者中细胞排斥反应的显著发作。
Endomyocardial biopsy is commonly used to screen for cellular rejection in pediatric heart transplant patients. The yield of EMBs when combined with newly developed immunohistochemical techniques and modern immunosuppression in pediatric heart transplant patients is unknown. After OHT, surveillance biopsies were performed on a routine basis on all pediatric patients. EMBs were also performed on symptomatic OHT patients suspected to have rejection. All positive results (greater than ISH LT grade 113) were confirmed with immunohistochemical staining. A retrospective review of consecutive EMBs performed in this institution from January 1995 to January 2003 was performed. The echocardiographic results, clinical history and treatment changes at the time of every biopsy were also catalogued. Of the 1093 EMB results from 136 pediatric heart transplant grafts (127 patients, 64 male) reviewed, 825 biopsies were performed on patients managed with tacrolimus and 268 were performed on patients managed with cyclosporine. The patients managed with tacrolimus had an incidence of 0.85% (7/825) for significant rejection (greater than ISHLT grade 1B rejection) vs. an incidence of 4.1% (11/268) for the patients on cyclosporine (p < 0.0005). In the asymptomatic tacrolimus patients, only two screening biopsies (0.26%) manifest significant rejection, and both of these were performed within the first month after transplantation. Of the symptomatic tacrolimus patients, 9.1% (n = 5) had findings on biopsy consistent with significant cellular rejection. There were 25 patients with grade 1B rejection. Twenty-two of these patients were not treated, and all cases of grade I B rejection resolved without clinical sequelae. For pediatric patients more than 30 days after OHT EMB, has failed to reveal significant episodes of cellular rejection in asymptomatic patients managed with tacrolimus.