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Algorithms for Management of Heart Transplant Rejection Based on Surveillance of Myocardial Damage by Antimyosin Antibody Imaging

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Cardiac Allograft Rejection

Abstract

Endomyocardial biopsy remains the only reliable diagnostic tool to detect acute allograft rejection (see Chapters 9,13)1–2. Biopsies are performed serially after transplantation, especially during the initial months. Immunosuppressive treatment is augmented when myocyte damage is detected by biopsy. Biopsy-based patient management is widely used and has been associated with very good long-term survival.3 However, there are significant limitations of endomyocardial biopsy. These include high procedural cost, a small but definite morbidity, and dwindling yield in obtaining adequate myocardial samples after the first year of transplantation. In addition, sampling error of the biopsy to detect acute rejection remains a major problem since myocardial expression of acute rejection is not a diffuse but rather a patchy. Rarely, patients who die of acute rejection demonstrate foci of myocardial damage and inflammation which can be seen surrounded by large areas of apparently intact myocardium.4,5

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Authors and Affiliations

  1. Department of Cardiology, Lleida University, Lleida, Spain

    Manel Ballester MD

  2. Department of Nuclear Medicine Hospital de Sant Pau, Barcelona, Spain

    Ignasi Carrió MD

  3. Heart Failure/Transplantation Center, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA

    Jagat Narula MD, PhD

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  1. Manel Ballester MD
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  2. Ignasi Carrió MD
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  3. Jagat Narula MD, PhD
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Editor information

Editors and Affiliations

  1. Heart Failure & Transplantation Service, Harvard Medical School, Bigelow 645, 55 Fruit Street, Boston, Massachusetts, 02114, USA

    G William Dec M.D.

  2. Heart Failure/Transplantation Center, Hahnemann University School of Medicine, Broad and Vine Streets, Mail Stop 115, Philadelphia, Pennsylvania, 19102, USA

    Jagat Narula M.D., Ph.D. (Director) (Director)

  3. Department of Cardiology, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Roure 80, 25198, Lleida, Spain

    Manel Ballester M.D. (Chairman) (Chairman)

  4. Nuclear Medicine Department, Hospital de Sant Pau, Autonomous University of Barcelona, Pare Claret 167, 08025, Barcelona, Spain

    Ignasi Carrio M.D. (Director) (Director)

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Ballester, M., Carrió, I., Narula, J. (2001). Algorithms for Management of Heart Transplant Rejection Based on Surveillance of Myocardial Damage by Antimyosin Antibody Imaging. In: Dec, G.W., Narula, J., Ballester, M., Carrio, I. (eds) Cardiac Allograft Rejection. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1649-1_20

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  • DOI: https://doi.org/10.1007/978-1-4615-1649-1_20

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