Biopsy-Negative Rejection: a Rare but Difficult Issue in Heart Transplantation

AbstractPurpose of ReviewBiopsy-negative rejection is a condition defined by a cardiac dysfunction with a left ventricular ejection fraction (LVEF) ≤ 45% with normal histology and with the absence of other causes of cardiac allograft damage. The purpose of this review is to determine the incidence of biopsy-negative rejection, the therapeutics, and the outcome in the light of new techniques of evaluation or detection of acute rejection in h eart-transplanted patients. Although rare, many physicians have once experienced this difficult situation. Even though it is considered the gold standard for the diagnosis of rejection, pathology is of limited help in biopsy-negative rejection by definition.Recent FindingsShowed advances made in the field of transplant medicine, such as cardiovascular magnetic resonance imaging, noninvasive biomarkers, and molecular assessment using transcriptomic analysis of the cardiac allograft tissue on endomyocardial biopsies.SummaryBiopsy-negative rejection marks the limit of histology; new techniques developed to improve the follow-up of heart transplant recipients could be of future help in the understanding of biopsy-negative rejection and maybe dethrone the biopsy for the diagnostic of acute rejection.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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There is a critical need for non-invasive methods to detect coronary allograft vasculopathy and to risk stratify heart transplant recipients. Vasodilator stress testing using cardiovascular magnetic resonance ...
Source: Journal of Cardiovascular Magnetic Resonance - Category: Radiology Authors: Tags: Research Source Type: research
We report identical diffuse subepicardial LGE in 2 highly allosensitized HT recipients who developed allograft failure. We postulate this LGE pattern may be related to antibody-mediated rejection and cardiac allograft vasculopathy, and portends poor outcomes. These cases illustrate a potential role of cardiac magnetic resonance for antibody-mediated rejection evaluation and risk stratification.RésuméLe rehaussement tardif après injection de gadolinium (RTG) observé à l’imagerie cardiaque par résonance magnétique est utile au pronostic chez les populations atteintes de ...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
AbstractPurpose of ReviewBiopsy-negative rejection is a condition defined by a cardiac dysfunction with a left ventricular ejection fraction (LVEF) ≤ 45% with normal histology and with the absence of other causes of cardiac allograft damage. The purpose of this review is to determine the incidence of biopsy-negative rejection, the therapeutics, and the outcome in the light of new techniques of evaluation or detection of acute rejection in h eart-transplanted patients. Although rare, many physicians have once experienced this difficult situation. Even though it is considered the gold standard for the diagnosis of ...
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research
AbstractA 6-month-old infant with a double outlet right ventricle, doubly committed ventricular septal defect, and right ventricle outflow tract (RVOT) stenosis underwent intracardiac repair with RVOT reconstruction using a fresh decellularized allograft derived from a 1-year-old heart transplant recipient in Japan. Early postoperative evaluation via echocardiography and cardiac magnetic resonance imaging revealed that the pulmonary allograft and cardiac function were stable. This is the first case report on using a decellularized heart valve, which was resected from a heart transplant recipient, for primary repair of cong...
Source: General Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Purpose: An accurate evaluation of left ventricular volumes, mass, and ejection fraction (EF) and an early exclusion or detection of significant coronary artery disease or cardiac allograft vasculopathy are mandatory for clinical management and prognosis assessment of heart-transplanted patients (HTP). The purpose of this article was to evaluate the role of dual-step prospective electrocardiography-triggered Dual-Source CT (pECGdual-step-DSCT) in HTP for the assessment of left-ventricular function, in comparison with echocardiography (echo) and cardiac magnetic resonance (CMR) performed on the same day, and of the corona...
Source: Journal of Thoracic Imaging - Category: Radiology Tags: Original Articles Source Type: research
In conclusion, MPRi and GLS are abnormal in late-stage OHT and ass ociated with CAV, but not related to allograft rejection, myocardial scar/fibrosis, or allograft dysfunction. Non-invasive monitoring of MPRi and GLS may be a useful strategy to detect CAV.
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
CONCLUSIONS: Decellularized heart valves could be the new material used as artificial heart valves. Pulmonary allografts derived from the hearts of heart transplant recipients are considered to be useful material for decellularized heart valves. The application of this valve to Japanese clinical circumstances and using the hearts of heart transplant recipients is considered to be very significant. PMID: 29657239 [PubMed - as supplied by publisher]
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
Objectives Heart transplantation (HTX) in mice is used to characterize gene-deficient mice and to test new treatment strategies. The purpose was to establish noninvasive magnetic resonance imaging techniques in mice to monitor pathophysiological changes of the allograft during rejection. Materials and Methods Magnetic resonance imaging was performed at baseline and days 1 and 6 after isogenic (n = 10, C57BL/6) and allogenic (n = 12, C57BL/6 to BALB/c) heterotopic HTX on a 7 T small animal scanner. Respiratory- and electrocardiogram-gated multislice multi-echo spin echo sequences were acquired, and parameter maps of T2...
Source: Investigative Radiology - Category: Radiology Tags: Original Articles Source Type: research
Cardiac magnetic resonance imaging (cMRI) appears to have a high negative predictive value when used as a screening tool for allograft rejection after heart transplantation (HTX). We sought to compare myocardial biopsy to cMRI screening to guide steroid withdrawal early after HTX.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Source Type: research
Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (cMRI) has been found to be common post heart transplant (HT) but not to correlate with the presence of acute rejection (AR) on endomyocardial biopsy (EMB). Additionally, LGE post HT comes in multiple patterns. It is not known if the pattern of LGE in this population is correlated with clinical outcomes. The purpose of the study was to identify the prevalence of different patterns of LGE seen on cMRI post HT and to analyze whether the pattern of LGE correlates with clinical outcomes of HT recipients.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Source Type: research
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