257 An Intensive Endomyocardial Biopsy (EMB) Surveillance Strategy Is Not Superior to a Conservative Strategy To Reduce Post Transplant Events: A 5-Year Follow-Up Study

Purpose: EMB surveillance after heart transplant remains the gold standard for monitoring acute cellular rejection for the first 5 years.The low yield of surveillance cardiac biopsies after 12 months post transplant does not support this approach. Our center adopted a conservative strategy where surveillance EMB is performed only during the first 6 months post transplant and thereafter as indicated. We aim to demonstrate that a conservative EMB surveillance strategy has similar outcomes compared to intensive strategy. Methods and Materials: Retrospective analysis of 2 EMB surveillance strategies was compared. Intensive strategy (EMB surveillance for five years) with 127 patients transplanted from 1990-1995 was compared to a conservative strategy (EMB surveillance only during first 6 months) 156 patients transplanted from 2003-2009. KM curves were constructed for the two groups and cause of death ascertained. Results: Outcomes for patients after six months were similar in both groups (p ns). Causes of death demonstrate that cardiovascular death was lower in the conservative strategy despite less intensive surveillance and non cardiovascular death were similar in two groups.