What is an endomyocardial biopsy? How often will I need one?

Rejection is the most common and serious complication after heart transplantation, especially during the first year. Because of the risk of rejection you need very careful monitoring and frequent heart muscle biopsies (endomyocardial biopsy). Rejection must be detected and treated quickly to prevent damage to the transplanted heart.

The follow-up and testing schedule after a transplant is fairly intense for the first few months. Half of all possible rejections occur in the first 6 weeks, and most happen within the first 6 months of surgery.

Heart transplant recipients are carefully monitored for signs of rejection. The best method of checking your new heart for any signs of rejection is to perform a heart muscle biopsy (endomyocardial biopsy). This procedure is performed in the cardiac catheterization laboratory. It is usually an outpatient procedure that takes less than 1 hour to perform; you can return home after the procedure. Biopsies are scheduled routinely by your transplant team but may also be done if you develop any new symptoms that might suggest possible rejection.

Under local anesthetic a small catheter (a fine, hollow tube) is introduced through a vein in the neck and is passed into the heart, using an x-ray machine for guidance. This technique is very similar to a right heart catheterization procedure. At the tip of the catheter is a bioptome, which is a tiny tweezer-like instrument that is used to snip off a very small piece of heart muscle tissue. You will not feel any pain from this procedure but may feel some slight pressure. Then, these very small specimens of heart muscle tissue (endomyocardium) are taken from the heart and withdrawn through the catheter. A small bandage is placed on the site where the doctor inserted the catheter into your neck vein.

These biopsies are examined under the microscope for any signs of damage to the heart. If the biopsy shows any signs of damage to the heart cells due to rejection, the dose and kind of your immunosuppressant medications may be changed to further suppress the rejection.

You need to undergo periodic biopsies to make certain that even the earliest signs of rejection are detected. In the weeks after transplantation the cardiac biopsies occur more frequently; as time goes on these biopsies become less frequent. For each transplant recipient, depending on the biopsy results, the biopsy schedule varies.

Endomyocardial biopsies are usually scheduled weekly for the first 4 weeks after transplant and then every other week for about 1 to 2 months. After that, biopsies usually occur every 1 to 3 months for the first year and then once per year thereafter. After your yearly exam and biopsy, the schedule of biopsies depends on your transplant doctor and the amount of rejection detected, if any.