Acute Rejection, Heart

GENERAL PRINCIPLES

Heart transplant recipients typically have 2-3 episodes of acute rejection in the first year after transplantation with a 50%-80% chance of having at least one rejection episode, most commonly in the first 6 months.

DIAGNOSIS

• Diagnosis is established by endomyocardial biopsy performed during routine surveillance or as prompted by symptoms. Noninvasive techniques have not demonstrated sufficient sensitivity and specificity to replace the endomyocardial biopsy. Repeated endomyocardial biopsies predispose to severe tricuspid regurgitation.

• Manifestations may include symptoms and signs of left ventricular dysfunction, such as dyspnea, paroxysmal nocturnal dyspnea, orthopnea, syncope, palpitations, new gallops, and elevated jugular venous pressure. Many patients are asymptomatic. Acute rejection can also be associated with a

variety of tachyarrhythmias (atrial more often than ventricular).