Biopsy Procedure is a Heart Transplant Necessity

The folks at the U of MN are making plans for my first "heartaversary" status visit.  It will include a biopsy and a series of other procedures and tests. The chances of rejection are ever present and life long.  The body has a one track approach to a "foreign organ":  kill it.

Everyone fortunate enough to receive an organ transplant is subject to having the organ--heart, kidneys, liver--attacked by the body's self-defense system. To even the odds for survival, cardiologists use a drug regimen that suppresses that self-defense or immune system.  But even with immuno-suppressant meds, the body still wants to annihilate the foreign organ.

A significant problem in the "rejection" arena is that the recipient of the gift of life doesn't feel a thing. There are likely no symptoms or pain.

One of the methods of determining whether a heart transplant recipient is rejecting the donated heart is to take some tissue samples from the organ and have a pathologist examine them under a microscope.

There are two types of rejection: acute cellular (most common) and humoral or vascular.

The pathologist can assess "rejection" by examining cells, looking for signs of the body attacking the new heart.  Typically, rejection occurs in the first few months after the transplant operation.  My "acute rejection" was detected after less than three months.  My episode of rejection lasted for a week. I'm told the treatment is high doses of Prednisone (a steroid) by IV for 72 hours.  The dosage for me was 1,000 mg per day and was administered in the hospital. 

The protocol at the U of Minnesota is to have regular biopsies during the first year on a set schedule with additions as necessary.  I think I'm over a dozen so far since last June 8, and there are three months left before my first "heartaversary".

For those who do not know about the procedure, here is what happens.

Typically for me, I report an hour before the scheduled procedure to the Cardiac Catheterization Lab. My vital signs are recorded and a nurse reviews all my medications with me.

The procedure is performed by a cardiologist under sterile conditions.  The whole area is painted (in this case blue) with a liquid that kills whatever is on my skin.  

Lidocaine, a topical anesthetic, is injected into my right neck area at the Jugular vein. A small cut is made in my neck to allow the cardiologist to insert a Swan-Ganz catheter into this large vein.

Pressures on the right side of the heart are measured to determine my heart's efficiency.  All pressures have been good so far.

Another catheter is guided through the Swan-Ganz into the right side of my heart.  This catheter has the capability to take tiny samples (usually four to six) of the heart tissue.  These are the samples that are examined to determine rejection.

The doctor uses X-ray and Doppler machines to guide the catheters  during the procedure which lasts about 20 minutes.

Once the pressures are assessed and the samples are taken, the doctor removes the catheters.  Pressure is applied to the wound site, the blue dye and I leave with a Bandaid.  Someone complained about the Snoopy Bandaids that were used for a long time after the procedure. 

They were among the first bandages to be latex free but were discontinued after the complaint.  This last time, a week ago, I asked for a Snoopy Bandaid, was told the lab didn't use them anymore, but the nurse obliged me by drawing a dog on my bandage before applying it to my neck.

There is another procedure called an Allomap used for testing for active rejection.  I may write about that later.  That's enough information unless you are a cardiology resident, right?