{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:38:06Z","timestamp":1791567486151,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,12,1]],"date-time":"2018-12-01T00:00:00Z","timestamp":1543622400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Due to limited and conflicting data in pediatric patients, long\u2010term routine surveillance endomyocardial biopsy (RSB) in pediatric heart transplant (HT) remains controversial. We sought to characterize the rate of positive RSB and determine factors associated with RSB\u2010detected rejection. Records of patients transplanted at a single institution from 1995 to 2015 with &gt;2\u00a0year of post\u2010HT biopsy data were reviewed for RSB\u2010detected rejections occurring &gt;2\u00a0year post\u2010HT. We illustrated the trajectory of significant rejections (ISHLT Grade \u22653A\/2R) among total RSB performed over time and used multivariable logistic regression to model the association between time and risk of rejection. We estimated Kaplan\u2010Meier freedom from rejection rates by patient characteristics and used the log\u2010rank test to assess differences in rejection probabilities. We identified the best\u2010fitting Cox proportional hazards regression model. In 140 patients, 86% did not have any episodes of significant RSB\u2010detected rejection &gt;2\u00a0year post\u2010HT. The overall empirical rate of RSB\u2010detected rejection &gt;2\u00a0year post\u2010HT was 2.9\/100 patient\u2010years. The percentage of rejection among 815 RSB was 2.6% and remained stable over time. Years since transplant remained unassociated with rejection risk after adjusting for patient characteristics (OR\u00a0=\u00a00.98; 95% CI 0.78\u20101.23;\n                    <jats:italic>P\u00a0<\/jats:italic>\n                    =\u00a00.86). Older age at HT was the only factor that remained significantly associated with risk of RSB\u2010detected rejection under multivariable Cox analysis (\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0=\u00a00.008). Most pediatric patients did not have RSB\u2010detected rejection beyond 2\u00a0years post\u2010HT, and the majority of those who did were older at time of HT. Indiscriminate long\u2010term RSB in pediatric heart transplant should be reconsidered given the low rate of detected rejection.\n                  <\/jats:p>","DOI":"10.1111\/petr.13330","type":"journal-article","created":{"date-parts":[[2018,12,1]],"date-time":"2018-12-01T07:34:24Z","timestamp":1543649664000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Long\u2010term surveillance biopsy: Is it necessary after pediatric heart transplant?"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7763-7518","authenticated-orcid":false,"given":"David M.","family":"Peng","sequence":"first","affiliation":[{"name":"Department of Pediatrics Stanford University School of Medicine Palo Alto California"},{"name":"Betty Irene Moore Children's Heart Center Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria Y.","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth A.","family":"Hollander","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University School of Medicine Palo Alto California"},{"name":"Betty Irene Moore Children's Heart Center Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tigran","family":"Khalapyan","sequence":"additional","affiliation":[{"name":"Clinical and Translational Research Program Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Dykes","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University School of Medicine Palo Alto California"},{"name":"Betty Irene Moore Children's Heart Center Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David N.","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University School of Medicine Palo Alto California"},{"name":"Betty Irene Moore Children's Heart Center Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Almond","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University School of Medicine Palo Alto California"},{"name":"Betty Irene Moore Children's Heart Center Palo Alto California"},{"name":"Clinical and Translational Research Program Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Sakarovitch","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manisha","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doff B.","family":"McElhinney","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University School of Medicine Palo Alto California"},{"name":"Betty Irene Moore Children's Heart Center Palo Alto California"},{"name":"Clinical and Translational Research Program Palo Alto California"},{"name":"Department of Cardiothoracic Surgery Stanford University School of Medicine Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1973.03220300044010"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.hco.0000210309.71984.30"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.114.001199"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2012.07.023"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2007.00687.x"},{"key":"e_1_2_9_7_1","first-page":"Ii236\u201041","article-title":"Rejection after cardiac transplantation. A time\u2010related risk factor analysis","volume":"86","author":"Kirklin JK","year":"1992","journal-title":"Circulation"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3046.2000.00100.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1053-2498(00)00228-X"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000000615"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2012.02.010"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.12998"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2012.03.015"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2006.10.003"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1053-2498(02)01154-3"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(97)00732-7"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199802270-00014"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1053-2498(01)00236-4"},{"key":"e_1_2_9_19_1","first-page":"409","article-title":"Risk factors for late recurrent rejection after heart transplantation: a multiinstitutional, multivariable analysis. Cardiac Transplant Research Database Group","volume":"14","author":"Kubo SH","year":"1995","journal-title":"J Heart Lung Transplant"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(05)80012-0"},{"key":"e_1_2_9_21_1","first-page":"1052","article-title":"Routine surveillance myocardial biopsies are unnecessary beyond one year after heart transplantation","volume":"14","author":"White JA","year":"1995","journal-title":"J Heart Lung Transplant"},{"key":"e_1_2_9_22_1","first-page":"1047","article-title":"Is it necessary to perform surveillance endomyocardial biopsies in heart transplant recipients?","volume":"14","author":"Sethi GK","year":"1995","journal-title":"J Heart Lung Transplant"},{"key":"e_1_2_9_23_1","first-page":"912","article-title":"Role of routine endomyocardial biopsy to monitor late rejection after heart transplantation","volume":"10","author":"Spratt P","year":"1991","journal-title":"J Heart Lung Transplant"},{"key":"e_1_2_9_24_1","first-page":"Iii106\u201010","article-title":"Predictors of late acute orthotopic heart transplant rejection","volume":"80","author":"Winters GL","year":"1989","journal-title":"Circulation"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1053-2498(02)00819-7"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1053-2498(03)00059-7"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2016.09.017"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1053-2498(02)00551-X"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1053-2498(03)00209-2"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1053-2498(00)00080-2"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(00)70108-9"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(00)01454-5"},{"key":"e_1_2_9_33_1","first-page":"1095","article-title":"Utility of surveillance biopsies in infant heart transplant recipients","volume":"14","author":"Balzer DT","year":"1995","journal-title":"J Heart Lung Transplant"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)90766-8"},{"key":"e_1_2_9_35_1","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1111\/j.1399-0012.1998.tb01089.x","article-title":"Usefulness of surveillance endomyocardial biopsy after pediatric cardiac transplantation","volume":"12","author":"Braunlin EA","year":"1998","journal-title":"Clin Transplant"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1397-3142.2003.00115.x"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.05.111"},{"key":"e_1_2_9_38_1","first-page":"587","article-title":"A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group. The International Society for Heart Transplantation","volume":"9","author":"Billingham ME","year":"1990","journal-title":"J Heart Transplant"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2005.03.019"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2016.08.018"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13197"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.04.033"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpetr.13330","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.13330","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T07:53:38Z","timestamp":1775289218000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.13330"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12]]},"references-count":41,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,2]]}},"alternative-id":["10.1111\/petr.13330"],"URL":"https:\/\/doi.org\/10.1111\/petr.13330","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12]]},"assertion":[{"value":"2018-07-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-11-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13330"}}