Key result
Surveillance with gene expression profiling and donor-derived cell-free DNA in 18 heart transplant recipients >1 year post-transplant led to 9 biopsies, with only one showing significant rejection.
Why the study?
Gene expression profiling (GEP) and donor-derived, cell-free DNA (dd-cfDNA) are alternatives to endomyocardial biopsy, and authors aimed to describe their use in heart transplant recipients > 1-year post-transplantation.
Does surveillance with GEP and dd-cfDNA accurately detect allograft rejection in heart transplant patients > 1 year post-transplant?
Observational (n=18)
No
Does surveillance with GEP and dd-cfDNA accurately detect allograft rejection in heart transplant patients > 1 year post-transplant?
The combined use of GEP and dd-cfDNA for rejection surveillance >1 year post-heart transplant may lead to an increased number of biopsies with a low yield for significant rejection unless both markers are elevated.
May increase low-yield biopsies with combined GEP/dd-cfDNA surveillance >1 year post-transplant; leaves open optimal thresholds for rejection detection.
BACKGROUND: Gene expression profiling (GEP) and donor-derived, cell-free DNA (dd-cfDNA) measurement are alternative methods to endomyocardial biopsy (EMB) to monitor for rejection following heart transplantation. We aim to describe our use of GEP and dd-cfDNA in heart transplant recipients > 1-year post-transplantation. METHODS: This is a single-center, retrospective study in post-transplant recipients. For patients who were > 1-year post-transplantation and deemed to be at elevated clinical risk for rejection, we collected both GEP and dd-cfDNA every 3 months. Baseline characteristics including GEP, dd-cfDNA levels, rejection episodes, and number of biopsies were obtained. RESULTS: Since July 2019, there were 18 patients being followed with GEP and dd-cfDNA who were > 1-year post-transplantation. Nine EMBs had been performed in seven patients due to as follows; three due to elevated GEP ({greater than or equal to} 34), one due to elevated dd-cfDNA ({greater than or equal to} .20%), two due to elevations of both GEP and dd-cfDNA, two due to clinical rejection and one to follow up a post rejection episode. One of the two biopsies due to elevations of both GEP and dd-cfDNA showed acute cellular rejection grade 2R. None of the biopsies due to either an elevation in the GEP or dd-cfDNA revealed any significant rejection. CONCLUSION: In this study, the use of both GEP and dd-cfDNA led to an increased number of EMB in patients > 1-year post-transplantation. Further studies are needed to validate these findings and evaluate long-term consequences of these diagnostic tests in this population.
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Kewcharoen et al. (2021) conducted an observational in Heart transplant recipients > 1-year post-transplantation (n=18). Gene expression profiling (GEP) and donor-derived, cell-free DNA (dd-cfDNA) was evaluated on Endomyocardial biopsies and rejection episodes. Surveillance with gene expression profiling and donor-derived cell-free DNA in 18 heart transplant recipients >1 year post-transplant led to 9 biopsies, with only one showing significant rejection.
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