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Heart transplant biopsies: interpretation and significance
  1. V Nair1,2,3,
  2. J Butany1,2
  1. 1
    Department of Pathology, Toronto General Hospital/University Health Network, Toronto, Ontario, Canada
  2. 2
    University of Toronto, Toronto, Ontario, Canada
  3. 3
    McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Jagdish Butany, Department of Pathology, Toronto General Hospital, 11th floor, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; jagdish.butany{at}


The endomyocardial biopsy(EMB) is a valuable tool that is inadequately utilised, except in monitoring orthotopic, homograft, heart grafts. Performed on a regular, programmed schedule, or on an emergent basis when needed, the EMB is the gold standard for monitoring graft function ( with regard to cellular rejection), often before clinical symptoms develop. This paper addresses these points and discusses handling of tissues and some studies for possible antibody mediated rejection when the lack of morphologic features of cellular rejection does not fit with the patients clinical presentation, days or months after the surgical procedure. In the hands of a skilled operator the EMB procedure is relatively painless and free of signicicant complications.

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  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.