Patient radiation exposure during invasive graft surveillance after heart transplantation
L Sazgary, E Theano Samara, F Mikulicic, M Frank, D Parianos, M Nagele, F Ruschitzka, A J Flammer, A SagunerAbstract
Background
Invasive procedures, including endomyocardial biopsy (EMB), right heart catheterization (RHC) and coronary angiography (CA), are essential components of graft surveillance after heart transplantation (HTx). Fluoroscopy remains the primary imaging modality. Data on patient radiation exposure in HTx recipients is limited.
Purpose
The aim of this study was to establish typical values for radiation in these procedures, assess trends in patient radiation exposure over time, and identify the procedures contributing most to cumulative radiation during post-transplant surveillance.
Methods
Retrospective cohort study at a tertiary care center including patients that underwent heart transplantation between January 2018 and December 2019. All patients were followed through their invasive organ surveillance period. Patient radiation exposure was assessed using the kerma area product (KAP, dGy.cm2), peak-skin dose (PSD, mGy) and fluoroscopy time (seconds). Secondary endpoints were procedural success rate and procedure related complications.
Results
Among 382 procedures in 20 HTx patients, 330 (86.4%) were EMB, 22 (5.8%) EMB plus RHC, and 30 (7.8%) EMB plus CA with or without RHC. In the first post-transplant year, the mean cumulative radiation exposure per patient was 509 ± 39.5 dGy.cm2, decreasing to 111 ± 61.3 dGy.cm2 by year five (p < 0.001). By day 387 after HTx 50% of the cumulative radiation exposure was reached. Annual radiation peaks beyond the first year were mainly due to CA procedures (Figure 1). There was a significant reduction in radiation exposure per EMB over time (p = 0.002) (Figure 2). Procedural success rate was 98.2% and procedure related complications occurred in 4 (1%) cases.
Conclusion
Radiation exposure in HTx recipients is highest during the first post-transplant year, with coronary angiography contributing most to later exposure peaks. These findings highlight the importance of time- and procedure-specific strategies to reduce radiation burden and optimize long-term surveillance protocols. Further studies are needed to explore targeted interventions to further minimize radiation exposure while maintaining diagnostic efficacy.KAP over time.For image description, please refer to the figure legend and surrounding text.KAP per EMB procedure over time.For image description, please refer to the figure legend and surrounding text.