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Single‐center utilization of donor‐derived cell‐free DNA testing in the management of heart transplant patients
Author(s) -
Gondi Keerthi T.,
Kao Andrew,
Linard Jodie,
Austin Bethany A.,
Everley Mark P.,
Fendler Timothy J.,
Khumri Taiyeb,
Lawhorn Stephanie L.,
Magalski Anthony,
Nassif Michael E.,
Sperry Brett W.,
Vodnala Deepthi,
Borkon A. Michael
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14258
Subject(s) - medicine , cell free fetal dna , endomyocardial biopsy , single center , heart transplantation , biopsy , cardiology , transplantation , oncology , pregnancy , fetus , genetics , prenatal diagnosis , biology
Background Gene expression profiling (GEP) and donor‐derived cell‐free DNA (dd‐cfDNA) are useful in acute rejection (AR) surveillance in orthotopic heart transplant (OHT) patients. We report a single‐center experience of combined GEP and dd‐cfDNA testing for AR surveillance. Methods GEP and dd‐cfDNA are tested together starting at 2 months post‐OHT. After 6 months, combined testing was obtained before scheduled endomyocardial biopsy (EMB), and EMB was canceled with a negative dd‐cfDNA. This approach was compared to using a GEP‐only approach, where EMB was canceled with a negative GEP. We evaluated for frequency of EMB cancellation with dd‐cfDNA usage. Results A total of 153 OHT patients over a 13‐month period underwent 495 combined GEP/dd‐cfDNA tests. 82.2% of dd‐cfDNA tests were below threshold. Above threshold results identified high‐risk patients who developed AR. 378 combined tests ≥6 months post‐OHT resulted in cancellation of 83.9% EMBs as opposed to 71.2% with GEP surveillance alone. There were 2 acute cellular and 2 antibody‐mediated rejection episodes, and no significant AR ≥6 months. Conclusion Routine dd‐cfDNA testing alongside GEP testing yielded a significant reduction in EMB volume by re‐classifying GEP (+) patients into a lower risk group, without reduction in AR detection. The addition of dd‐cfDNA identified patients at higher risk for AR.