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 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 calledfluoroscopy 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. While this method has not replaced the endomyocardial biopsy as the gold standard, it has decreased the frequency of biopsies for many patients.
Why aren't more heart transplants done?
It's not easy to qualify for a heart transplant. One has to have a very bad heart but an otherwise healthy body. However, the major limiting factor is the availability of donor hearts. For many reasons, individuals and families refuse to donate organs that could be life-saving to others. Sometimes, even when an organ is available, there is no good match. Other times, there is no way to get the heart to a suitable recipient in time for the organ to still be viable. Cost is another reason, although less frequent, why more heart transplants aren't done. The cost is always at least a few hundred thousand dollard. Not all insurers will pay for heart transplant. The longer the recipient lives, the more expensive the transplant. Of course, if the heart lasts longer, the benefit is also greater to the patient and to society.
Medically Reviewed by a Doctor on 2/14/2014