Virtual biopsy could transform heart transplant care

Approximately 3500 people worldwide receive heart transplants each year. Most patients experience some form of organ rejection, and while survival rates are high, a small percentage will die in the first year after surgery.

Most clinicians around the world currently test for rejection by performing a biopsy, which helps determine the level and suitability of immunosuppressive treatments needed to treat and prevent further rejection. This invasive procedure involves a tube being placed in the jugular vein to allow surgeons to insert a biopsy tool into the heart to remove multiple samples of heart tissue, said Victor Chang Cardiac Research Institute in a statement.

“As well as being uncomfortable, it can also lead to rare but serious complications if the heart is perforated, or a valve is damaged. Patients usually undergo a biopsy around 12 times in the first year after transplantation.”

Now, a new virtual biopsy that takes less time, is non-invasive, more cost-effective, uses no radiation or contrast agents, can detect any signs of the heart being rejected. Scientists at the Victor Chang Cardiac Research Institute and St Vincent’s Hospital, Sydney, are hoping it will be adopted by clinicians the world over.

Andrew Jabbour, Associate Professor, Victor Chang Cardiac Research Institute and Consultant Cardiologist at St Vincent’s Hospital Sydney, said, “It’s essential that we can monitor these patients closely and with a high degree of accuracy; the new biopsy can do just that without the need for a highly invasive procedure.”

The new MRI technique is said to have been proven to be accurate in detecting rejection and works by analysing heart oedema levels which the team demonstrated are closely associated with inflammation of the heart.

Biopsy vs MRI

Forty heart transplant patients from St Vincent’s Hospital Sydney were randomised into receiving either a traditional biopsy or the new MRI technique.

Secondary findings of the study revealed that despite similarities in immunosuppression requirements, kidney function and mortality rates, there was a reduction in hospitalisation and infection rates for those who underwent the MRI procedure vs a biopsy. Also, just 6% of patients having the new MRI technique needed a biopsy for clarification reasons. These secondary findings are earmarked to be reconfirmed in planned larger multi-centre studies.

Fellow author and cardiologist Dr Chris Anthony, who helped conduct the study, said: “The technique is now frequently used at St Vincent’s Hospital in Sydney, and I anticipate that more clinics across the world will adopt this novel technology.”

Next steps

The team at the Institute and St Vincent’s is now planning a larger multi-centre trial to broaden the applicability of the findings and incorporate paediatric transplant recipients.

They are also developing new genetic testing to be used alongside the MRI, which it is hoped will detect signs of rejection through identifying genetic signals of donor-specific inflammation in the bloodstream. The new technique will also be adapted to detect heart inflammation in the wider population, not just transplant recipients.

Image caption: Associate Professor Andrew Jabbour. Image courtesy of Victor Chang Cardiac Research Institute.