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Int J Clin Exp Pathol 2013;6(1):55-65

Original Article
Endomyocardial biopsy for monitoring heart transplant patients: 11-years-experience at
a german heart center

Thomas Strecker, Johannes Rösch, Michael Weyand, Abbas Agaimy

Center of Cardiac Surgery and 2Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Germany

Received October 19, 2012; Accepted November 10, 2012; Epub November 20, 2012; Published January 1, 2013

Abstract: Background: Heart transplantation (HTX) has become an established therapy for patients with end-stage heart failure.
Endomyocardial biopsy (EMB) still represents the gold standard for routine surveillance of heart transplant rejection. The objective of this article
is to report our experience regarding the use of EMB in monitoring heart transplant recipients. Methods: We evaluated retrospectively all
patients who underwent orthotopic HTX between 2000 and 2011 at our hospital. From all patients, we created a follow-up, determined the
number of EMB events and described the complications associated with this procedure. Results: HTX was performed in 142 cases at our
center in the last 11 years (1.3% of the total of 10693 cardiac surgical operations in that period). Further 9 patients visited our department for
monitoring after HTX performed at an external center (total: 151). For all patients, a total of 1896 EMB events have been recorded. The majority
of biopsies were performed through the right internal jugular vein. The overall complication rate was 1% (n=19). Conclusions: The histological
examination of right ventricular EMB still represents the gold standard of care for cardiac allograft rejection monitoring. EMB is an invasive, but
safe and dedicated diagnostic procedure. However, the usefulness of recent non-invasive diagnostic approaches as an adjunct tool in
monitoring for rejection remains to be further analyzed. (IJCP1210008).

Keywords: Endomyocardial biopsy, cardiac transplantation, allograft rejection, histopathological evaluation, immunosuppression

Address all correspondence to:
Dr. Thomas Strecker
Center of Cardiac Surgery
Friedrich-Alexander- University Erlangen-Nuremberg
Krankenhausstrasse 12, 91054 Erlangen, Germany.
Phone: +49-9131-85-33985; Fax: +49-9131-85-36088
E-mail: thomas.strecker@uk-erlangen.de