1
|
Gondi KT, Kao A, Linard J, Austin BA, Everley MP, Fendler TJ, Khumri T, Lawhorn SL, Magalski A, Nassif ME, Sperry BW, Vodnala D, Borkon AM. Single-center utilization of donor-derived cell-free DNA testing in the management of heart transplant patients. Clin Transplant 2021; 35:e14258. [PMID: 33606316 DOI: 10.1111/ctr.14258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/02/2021] [Accepted: 02/13/2021] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Keerthi T Gondi
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Andrew Kao
- Department of Cardiovascular Medicine, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| | - Jodie Linard
- Department of Cardiac Transplant, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| | - Bethany A Austin
- Department of Cardiovascular Medicine, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| | - Mark P Everley
- Department of Cardiovascular Medicine, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| | - Timothy J Fendler
- Department of Cardiovascular Medicine, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| | - Taiyeb Khumri
- Department of Cardiovascular Medicine, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| | - Stephanie L Lawhorn
- Department of Cardiovascular Medicine, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| | - Anthony Magalski
- Department of Cardiovascular Medicine, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| | - Michael E Nassif
- Department of Cardiovascular Medicine, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| | - Brett W Sperry
- Department of Cardiovascular Medicine, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| | - Deepthi Vodnala
- Department of Cardiovascular Medicine, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| | - A Michael Borkon
- Department of Cardiothoracic Surgery, Mid America Heart Institute, Saint Luke's Health System Kansas City, Kansas City, MO, USA
| |
Collapse
|