Research Article| Volume 57, P41-44, January 2023

Download started.


Heart transplant Recipients’ perspectives on invasive versus Non-invasive graft failure surveillance Methods


      • 8 events reported at access site from EMB vs 3 events from AlloMap® testing.
      • Patients experienced less pain from an AlloMap® test than from an EMB.
      • There was no significant difference in the anxiety levels and adverse events.



      Heart transplant recipients must regularly be assessed for graft rejection; however, endomyocardial biopsy (EMB), can be stressful, painful, and inconvenient. AlloMap® is the only commercially available non-invasive test for graft rejection. Current guidelines include AlloMap® testing in low-risk patients


      To examine the patients’ perspective, this study compared patients’ experiences of AlloMap® and EMB surveillance at our center.


      We enrolled consecutive heart transplant recipients who were to undergo routine EMB and AlloMap® testing (on different visits) to quantify their anxiety on the GAD-7 scale and their pain level on the Polyclinic Pain Scale. We assessed paired differences of anxiety and pain within patients according to surveillance method.


      We studied 43 participants (median age 60.5[54, 66] years; 35(81%) men; 27(63%) Caucasian). The median GAD-7 scores were 1[0, 4] and 2[0, 5] prior to EMB and AlloMap®, respectively (paired difference: 0[-1, 1],P = 0.323). The median pain scores were 1[0, 1] and 0[0, 0] for EMB and AlloMap®, respectively. Patients experienced less pain with AlloMap® testing compared to EMB (EMB–AlloMap;1[0, 1],P = 0.006). Seven (16%) participants experienced a total of 9 adverse events (pain, bruising, bleeding, swelling) from EMB vs 2(5%) participants who experienced a total of 3 adverse events (pain, bruising) from AlloMap®(P = 0.059).


      Heart transplant recipients had less pain and fewer adverse events while undergoing graft rejection surveillance with AlloMap® testing compared to EMB. An additional benefit of AlloMap® testing is that it may be performed at home and reduce these high-risk patients’ infectious exposures.

      Key Words


      EMB (Endomyocardial biopsy), GAD-7 (Generalized anxiety disorder-7), GEP (Gene expression profile)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Crespo-Leiro M.G.
        • Stypmann J.
        • Schulz U.
        • et al.
        Clinical usefulness of gene-expression profile to rule out acute rejection after heart transplantation: CARGO II.
        Eur Heart J. 2016 Sep 1; 37 (Epub 2016 Jan 7. PMID: 26746629; PMCID: PMC5015661): 2591-2601
        • Fang K.C.
        Clinical utilities of peripheral blood gene expression profiling in the management of cardiac transplant patients.
        J Immunotoxicol. 2007 Jul; 4 (PMID: 18958730; PMCID: PMC2409185): 209-217
        • Kransdorf E.P.
        • Kobashigawa J.A.
        Genetic and genomic approaches to the detection of heart transplant rejection.
        Per Med. 2012 Sep; 9 (PMID: 29776273): 693-705
        • Fujita B.
        • Prashovikj E.
        • Schulz U.
        • et al.
        Predictive value of gene expression profiling for long-term survival after heart transplantation.
        Transpl Immunol. 2017 Mar; 41 (Epub 2017 Feb 4. PMID: 28167272): 27-31
        • Carey S.A.
        • Tecson K.M.
        • Jamil A.K.
        • Felius J.
        • Wolf-Doty T.K.
        • Hall S.A.
        Gene expression profiling scores in dual organ transplant patients are similar to those in heart-only recipients.
        Transpl Immunol. 2018 Aug; 49 (Epub 2018 Mar 26. PMID: 29588161): 28-32
        • Costanzo M.R.
        • Dipchand A.
        • Starling R.
        • et al.
        International society of heart and lung transplantation guidelines. The international society of heart and lung transplantation guidelines for the care of heart transplant recipients.
        J Heart Lung Transplant. 2010 Aug; 29 (PMID: 20643330): 914-956
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.
        • Löwe B.
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch Intern Med. 2006 May 22; 166 (PMID: 16717171): 1092-1097
      1. The Indiana Polyclinic Combined Pain Scale. PainScale Accessed February 2, 2021

        • Arbuck D.M.
        • Fleming A.
        Assessment and monitoring of pain: current tools. opioid prescribing and monitoring - (Second Edition).
        Practical Pain Manag (PPM). 2019; (Published April 29Accessed February 2, 2021)
        • Almgren M.
        • Lennerling A.
        • Lundmark M.
        • Forsberg A.
        The meaning of being in uncertainty after heart transplantation - an unrevealed source to distress.
        Eur J Cardiovasc Nurs. 2017 Feb; 16 (Epub 2016 Jul 7. PMID: 27146379): 167-174
        • Fusar-Poli P.
        • Martinelli V.
        • Klersy C.
        • et al.
        Depression and quality of life in patients living 10 to 18 years beyond heart transplantation.
        J Heart Lung Transplant. 2005 Dec; 24 (Epub 2005 Nov 17. PMID: 16364881): 2269-2278
        • Kugler C.
        • Geyer S.
        • Gottlieb J.
        • Simon A.
        • Haverich A.
        • Dracup K.
        Symptom experience after solid organ transplantation.
        J Psychosom Res. 2009 Feb; 66 (Epub 2008 Dec 18. PMID: 19154852): 101-110
        • Nilsson M.
        • Forsberg A.
        • Bäckman L.
        • Lennerling A.
        • Persson L.O.
        The perceived threat of the risk for graft rejection and health-related quality of life among organ transplant recipients.
        J Clin Nurs. 2011 Jan; 20 (Epub 2010 Oct 22. PMID: 20964748): 274-282
        • Kobashigawa J.
        • Patel J.
        • Azarbal B.
        • et al.
        Randomized pilot trial of gene expression profiling versus heart biopsy in the first year after heart transplant: early invasive monitoring attenuation through gene expression trial.
        Circ Heart Fail. 2015 May; 8 (Epub 2015 Feb 19. PMID: 25697852): 557-564
        • Hanser S.B.
        • Mandel S.E.
        The effects of music therapy in cardiac healthcare.
        Cardiol Rev. 2005 Jan-Feb; 13 (PMID: 15596023): 18-23
        • McCaffrey R.
        • Taylor N.
        Effective anxiety treatment prior to diagnostic cardiac catheterization.
        Holist Nurs Pract. 2005 Mar-Apr; 19 (PMID: 15871589): 70-73
      2. Beckerman A., Grossman D., Marquez L. Cardiac catheterization: the patients' perspective. Heart Lung. 1995 May-Jun;24(3):213–9. doi: 10.1016/s0147-9563(05)80039-1. PMID: 7622395.

        • Choudhury T.
        • Lurz P.
        • Schäufele T.G.
        • et al.
        Radial versus femoral approach for left ventricular endomyocardial biopsy.
        EuroIntervention. 2019 Oct 20; 15 (PMID: 30741639): 678-684
        • Spruce L.
        Back to basics: social determinants of health.
        AORN J. 2019 Jul; 110 (PMID: 31246307): 60-69
        • Sivertsen B.
        • Relbo A.
        • Gullestad L.
        • et al.
        Selvvurdert helse og psykiske symptomer etter hjertetransplantasjon [Self-assessed health and psychological symptoms after heart transplantation].
        Tidsskr Nor Laegeforen. 2007 Dec 13; 127 (Norwegian. PMID: 18084359): 3198-3201