Unsuspected rejection episodes on routine surveillance endomyocardial biopsy post-heart transplant in paediatric patients.

The use of routine endomyocardial biopsies post-heart transplant in children remains controversial. It is generally accepted as the gold standard for detecting rejection, but details of the surveillance protocol, such as number and timing of biopsies, remain uncertain, with suggestions that recent advances in immunosuppressant therapy have obviated the need to perform surveillance biopsies. We retrospectively analysed results of endomyocardial biopsies performed in our unit since the introduction of a policy of three routine biopsies in the first six months post-transplantation.