Timing of the First Endomyocardial Biopsy
in Heart Transplantation after Induction
Immunosuppressive Therapy –
Experience from Canadian Heart Transplant Centre
Málek F., 1Kaan A., 1Straatman L., 1Cheung A., 1Ignaszewski A.
Department of Internal Medicine I Faculty Hospital Kralovske Vinohrady, Third School of Medicine, Charles University, Prague, Czech RepublicSt Paul’s Hospital, Vancouver, British Columbia, Canada
Background. The exact time point at which the first endomyocardial biopsy could be safely performed after the heart
transplantation has not been systematically studied. In an attempt to determine this time point in our population, the
number and severity of acute rejection episodes in the first eight weeks after the heart transplantation were assessed
in 91 patients who underwent the procedure at St Paul’s Hospital, Vancouver between September 1996 and December
Methods and Results. For the purpose of our analysis, acute rejection was defined as the grade ≥2 according the
International Society for Heart and Lung Transplantation (ISHLT). Three hundred and sixty two endomyocardial
biopsies were performed in 87 patients surviving to the first biopsy from one to eight weeks after the heart
In 85 patients who received induction immunosuppressive therapy, 13 episodes of acute rejection were identified. In
two patients who did not receive the induction therapy, three episodes of acute rejection occurred. Acute rejection
grade ISHLT 3 was found in 2 patients who did not receive induction therapy and in three patients who did. ISHLT
grade 4 rejection occurred at weeks 5 and 7 in two patients who received induction therapy. Only one patient who
received induction therapy had acute rejection within the first three weeks after the heart transplantation.
Conclusions. Our analysis reveals that the frequency of acute rejection within the first eight weeks after the heart
transplantation using induction therapy is low in this cohort, suggesting that the first routine endomyocardial biopsy
could be delayed until the week four post-transplant.
heart transplantation, endomyocardial biopsy.