Pediatric Biopsy Considerations

Pediatric biopsies for cardiac transplant are generally seen in pediatric hospitals or in institutions with joint adult and pediatric programs. Routine EMB for pediatric follow up is less frequent than adult transplants. Although all of the same information applies to pediatric cases as was described for adult cases, there are a few special features to be aware of that are covered here.

Biopsy size


Particularly for infant transplantions, the size of biopsy pieces can be significantly smaller in the pediatric population. This is a result of using smaller bioptomes due to narrower vascular access and the small size of the heart. Pediatric cases should still have a minimum of 3 pieces of tissue for evaluation.




Increased impression of cellularity

Myocytes of neonatal and pediatric hearts are significantly smaller than adolescent and adult myocytes. Thus, the overall nuclear to cytoplasmic ratio is such that the biopsies look significantly more cellular. If you are used to evaluating adult biopsies, you will want to keep this in mind and look specifically for lymphocytes, not just a higher N/C ratio. Also, pediatric endothelial cells can appear plumper and will stand out more on biopsy. Again, this is something to be aware of in this age population.

Increased cellularity Increased cellularity Increased cellularity

Rates of Rejection

In one of our institutions we observed that rates of rejection in the pediatric population (age 1-18) were roughly double that of the adult population. One of the biggest problems was medication compliance among teenage transplant patients. A second potential cause is more robust immune systems in children than in the elderly. If you find you are seeing more rejection among your pediatric population than an adult population, that is reasonable.


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