Heart Transplant (cont.)
Michael C. Fishbein, MD
Michael C. Fishbein, MD
Dr. Fishbein received his undergraduate and medical degrees from the University of Illinois. He completed a residency in anatomic and clinical pathology at Harbor General Hospital/UCLA Medical Center. He is board certified in anatomic and clinical pathology.
In this Article
How does a heart transplant patient know if he or she is rejecting the donor organ or developing an infection?
This is not an easy question to answer because many of the symptoms and signs of rejection and infection are the same. These include:
The more specific symptoms and signs of infection will vary greatly depending upon the site of infection within the body. Transplant patients who experience any of these findings need to seek medical attention immediately. The transplant physician will then do tests to determine whether the transplanted heart is functioning normally or not. If there is no evidence of rejection, a thorough search for infection will be performed so that the patient can be treated appropriately.
How is rejection of the organ diagnosed and monitored?
Currently, the gold standard for monitoring rejection is the endomyocardial biopsy. This is a simple operation for the experienced cardiologist and can be done as an outpatient procedure. First, a catheter is put into the jugular vein in the neck. From there, the catheter is advanced into the right side of the heart (right ventricle) using an x-ray method called fluoroscopy for guidance. The catheter has a bioptome at its end, a set of two small cups which can be closed to pinch off and remove small samples of heart muscle. The tissue is processed and placed on glass slides to be reviewed under the microscope by a pathologist. Based on the findings, the pathologist can determine whether or not there is rejection.
Immunosuppressive therapy is then adjusted, for example, increased if rejection is present. Investigators have tried to develop less invasive methods to monitor for rejection. There is a new high-tech analysis that can be done in a sample of blood that is very promising and much easier for the patient than the endomyocardial biopsy. This test looks at the expression of specific genes in cells in the blood. The amount of expression of key genes indicates whether or not rejection is occurring. Nevertheless, so far, no method has replaced the endomyocardial biopsy.