Patient and Provider Perspectives for Acute Rejection Surveillance Policy Changes in Heart Transplantation: A Mixed-Methods Study

Endomyocardial biopsies (EMB) are invasive procedures performed in heart transplant (HTx) patients for acute rejection surveillance. While EMB remains the reference standard, novel noninvasive assays, such as donor-derived cell-free DNA (dd-cfDNA), have been adopted by some centers to reduce the number of EMBs post-HTx. However, patient experience of EMBs and preferences for acute rejection surveillance are unknown. A mixed-methods design was used with 28 semi-structured patient interviews and 119 self-administered online survey questionnaires between January to June 2023. Additionally, we performed semi-structured interviews with 18 HTx providers. We identified three themes: patient anxiety associated with EMBs, consistent patient-provider communication related to EMBs, and trust in providers for choosing the acute rejection surveillance strategy. Thus, we conclude HTx patients trust their providers for determining the most appropriate policy for acute rejection surveillance. However, providers also indicated the need for more clinical trial evidence prior to changing the institutional policy for EMBs.