Daily noninvasive rejection monitoring improves long-term survival in pediatric heart transplantation Roland Hetzer, MD, PhD, Evgueni V Potapov, MD,

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Daily noninvasive rejection monitoring improves long-term survival in pediatric heart transplantation Roland Hetzer, MD, PhD, Evgueni V Potapov, MD, Johannes Müller, MD, Matthias Loebe, MD, Manfred Hummel, MD, PhD, Yuguo Weng, MD, Henning Warnecke, MD, PhD, Peter E Lange, MD, PhD The Annals of Thoracic Surgery Volume 66, Issue 4, Pages 1343-1349 (October 1998) DOI: 10.1016/S0003-4975(98)00809-1

Fig 1 Telemetric pacemaker, receiver coil plus skin electrode, and bedside receiver (current model). The Annals of Thoracic Surgery 1998 66, 1343-1349DOI: (10.1016/S0003-4975(98)00809-1)

Fig 2 Five-year-old child demonstrating recording method for intramyocardial electrogram through a bedside receiver (earlier model). The Annals of Thoracic Surgery 1998 66, 1343-1349DOI: (10.1016/S0003-4975(98)00809-1)

Fig 3 Original intramyocardial electrogram (IMEG) printout over 34 days. The heavy solid line represents the course of the average IMEG voltage as recorded every night, and the two thin lines mark the upper and lower levels of IMEG voltage variations. The asterisk marks a sudden drop in voltage from the previously stable level. Two days later, pulsed steroid rejection treatment was initiated and effected a return of voltage to the previous level after 6 days (triangle). The heart rate (dotted line) showed only minor rate increases during the rejection process. (HTx = heart transplantation.) The Annals of Thoracic Surgery 1998 66, 1343-1349DOI: (10.1016/S0003-4975(98)00809-1)

Fig 4 Actuarial survival for all patients indicates a 1-year survival rate of 74% and a 5-year survival rate of 68.2%. For comparison, the recent international registry survival curve [2] is added. (ISHLT = International Society of Heart and Lung Transplantation.) The Annals of Thoracic Surgery 1998 66, 1343-1349DOI: (10.1016/S0003-4975(98)00809-1)

Fig 5 Actuarial survival for 50 children discharged from hospital who were in intramyocardial electrogram group. Survival at 1 year was 100% and at 5 years, 94.3%. The Annals of Thoracic Surgery 1998 66, 1343-1349DOI: (10.1016/S0003-4975(98)00809-1)

Fig 6 Distribution of acute rejection episodes as observed by intramyocardial electrogram (IMEG) in all patients with IMEG recording. The rate of rejection is high early after transplantation and rapidly drops to occasional episodes. The horizontal lines indicate duration of adherence to IMEG protocol after transplantation. Some patients have been on this protocol for 5 years or longer. The Annals of Thoracic Surgery 1998 66, 1343-1349DOI: (10.1016/S0003-4975(98)00809-1)