More than 30,000 people throughout the world now live with a transplanted heart, thanks to advances in drugs which block transplant rejection. But even with modern drug therapy, rejection remains a constant hazard, and transplant recipients must be tested repeatedly for signs of renewed rejection. In practice, this requires an endomyocardial biopsy: a catheter is inserted through the jugular vein in the neck down into the right heart, and a small piece of heart muscle is removed for microscopic examination. This test is invasive, potentially hazardous, and expensive.

We have recently completed a three-year multicenter study of the breath test in heart transplant patients at seven academic medical centers in the USA. The research was supported by a grant from the National Heart Lung and Blood Institute of the National Institutes of Health. The results showed that a negative breath test was as accurate as a negative endomyocardial (right ventricle) biopsy, and that a breath test could potentially reduce the total number of biopsies performed by more than half, with no risk to patient safety.

In practice, the breath test can be used as a screening test for heart transplant rejection. If it is negative, there is no need to proceed to a biopsy because it will add no new information. An endomyocardial biopsy need only be performed if the breath test is positive. If you are interested in using the breath test for heart transplant rejection, please contact us at mphillips@menssanaresearch.com.

These findings have been reported in:

(PDF document) Phillips M, Cataneo RN, Greenberg J, Gunawardena R, Naidu A and Rahbari-Oskoui F: Effect of age on the breath methylated alkane contour, a display of apparent new markers of oxidative stress. Journal of Laboratory and Clinical Medicine 2000: 136: 243-9.

(PDF document) Phillips M, Boehmer JP, Cataneo RN, Cheema T, Eisen HJ, Fallon JT, Fisher PE, Gass A, Greenberg J, Kobashigawa J, Mancini D, Rayburn B and Zucker MJ: Heart Allograft Rejection: Detection with Breath Alkanes in Low Levels (the HARDBALL study) J American College of Cardiology 2002;1(40): 12-13

(PDF Document) Phillips M, Boehmer JP, Cataneo RN et al: Heart Allograft Rejection: Detection with Breath Alkanes in Low Levels (the HARDBALL study). The Journal of Heart and Lung Transplantation 2004: 23: 701-8.