Background: Endomyocardial biopsy is used in long-term follow-up of cardiac transplant recipients to detect sub-clinical rejection. The value of this for adults and children on triple-drug immunosuppression has been disputed. We investigated its value in children maintained on a steroid-free regime.
Methods: We used a retrospective review of annual surveillance biopsy results from children younger than 13 years at the time of cardiac transplant.
Results: In a series of 40 children older than 10 years, we found no evidence of rejection in 88/130 (67.7%) biopsies; 41/130 (31.5%) showed grade 1A rejection, and 1/130 (0.8%) showed grade 1B rejection. No grade 2, 3, or 4 biopsies were found. Nine patients with 1A rejection had subsequent grade 0 biopsies, without any adjustment in treatment. Seven children had treatment changes and repeat biopsies because of grade 1A biopsies.
Conclusion: Significant late rejection is rare even in children on steroid-free maintenance. It is unlikely to be detected unexpectedly, and the practice of indefinite routine biopsy in children who are well is not justified. Future use should focus on individuals at higher risk of rejection.