Findings of a multi-center study indicate that a noninvasive test is helpful for targeting patients at high risk for rejection following a heart transplant. Clinical results with 30 heart transplant recipients followed for at least three months were reported today at the International Society For Heart and Lung Transplantation Meeting in Chicago, Illinois. Howard J. Eisen, M.D., Medical Director of the Heart Transplantation Unit at Temple University Hospital, reported that "pacemaker guided monitoring has a high predictive value useful in determining heart rejection."
Heart recipients who experience acute cellular rejection within three months of a transplant were identified more often when using this pacemaker technique. In addition, a single diagnosis using an implanted pacemaker would have eliminated the need for more invasive biopsy tests in as much as 71% of the routine follow-up exams. "Based upon our results pacemaker guided monitoring could serve as an early warning for future rejection in heart recipients," says Dr. Eisen. A prospective clinical trial would further define the role of this new technology in detecting rejection and anagement of heart transplant patients.
On average these patients experience approximately two episodes of rejection during the first year with the first three months being the most critical period. Endomyocardial biopsy is the gold standard for diagnosis of transplant rejection. This invasive procedure involves obtaining samples of heart tissue for determining the presence and degree of T lymphocyte infiltration. Patients tolerate the major side effects of endomyocardial biopsy, which can include localized bleeding, infection and arrhythmias. According to Dr. Eisen, "there is clearly a need for a less invasive and therefore more cost effective approach to detecting the early warning signs of heart transplant rejection."
Scientific registry data from the United Network for Organ Sharing (UNOS) indicates that more than 3,900 patients are currently waiting for a heart transplant. Previous reports have indicated that 746 people died in the U.S., in 1996, due to a shortage of organs. The estimated survival rate for that fortunate enough to receive a heart transplant is about 75 to 80 percent.