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• W4362580218 abstract "PurposeThe prevalence of using endomyocardial biopsy (EMB) or gene expression profiling and donor derived cell-free DNA, i.e. HeartCare (HC), varies greatly among programs in the US. This study aims to determine if the frequency of surveillance after HT correlates with clinical outcomes.MethodsPatients from the multi-center Surveillance HeartCare Outcomes Registry (SHORE) with at least 1 year of follow-up were included. Multi-organ transplant and “for cause” HC or EMBs were excluded. EMBs were classified by tertiles of average number of surveillance within 1 year post HT: low <3, medium 3-5, high >5; HeartCare (HC) surveillance was classified as low <5, medium 5-8, high > 8. Clinical outcomes included rejection (ACR ≥2R, AMR ≥1), graft dysfunction (LVEF < 30% or drop of >25%), de novo donor specific antibodies (dnDSA), and ISHLT cardiac allograft vasculopathy Grade 2/3 (CAV) at 1 year post HT. Mortality was assessed after year 1 to account for lower testing rates in those who did not survive their first year.Results1882 patients met inclusion criteria (74% Male, 67% White, mean age 54 ±13 years). 7547 surveillance EMBs and 11,239 HC tests were performed during year 1 (mean 4 (±3) EMB/patient and 7 (±3) HC/patient). The incidence of rejection was 11.5%, including ACR ≥2R (5.8%) and AMR ≥1 (5.2%). Overall mortality was 2.9% (n=55). A higher incidence of rejection (mostly ACR) was noted in the high EMB group compared to low EMB (20.8% vs 3.7%, p<0.001); as well as high HC vs. low HC cohort (13.5% vs. 9.2%, p=0.04) and survival after 1 year was similar across groups (Figure 1A and 1B).ConclusionThis analysis highlights the varied surveillance practices across US hospitals. Higher levels of surveillance were associated with more frequent clinical outcomes when compared to lower surveillance in the first year post HT, which may be a reflection of a higher risk patient population. Further work is necessary to elucidate a preferred method and frequency of HT surveillance. The prevalence of using endomyocardial biopsy (EMB) or gene expression profiling and donor derived cell-free DNA, i.e. HeartCare (HC), varies greatly among programs in the US. This study aims to determine if the frequency of surveillance after HT correlates with clinical outcomes. Patients from the multi-center Surveillance HeartCare Outcomes Registry (SHORE) with at least 1 year of follow-up were included. Multi-organ transplant and “for cause” HC or EMBs were excluded. EMBs were classified by tertiles of average number of surveillance within 1 year post HT: low <3, medium 3-5, high >5; HeartCare (HC) surveillance was classified as low <5, medium 5-8, high > 8. Clinical outcomes included rejection (ACR ≥2R, AMR ≥1), graft dysfunction (LVEF < 30% or drop of >25%), de novo donor specific antibodies (dnDSA), and ISHLT cardiac allograft vasculopathy Grade 2/3 (CAV) at 1 year post HT. Mortality was assessed after year 1 to account for lower testing rates in those who did not survive their first year. 1882 patients met inclusion criteria (74% Male, 67% White, mean age 54 ±13 years). 7547 surveillance EMBs and 11,239 HC tests were performed during year 1 (mean 4 (±3) EMB/patient and 7 (±3) HC/patient). The incidence of rejection was 11.5%, including ACR ≥2R (5.8%) and AMR ≥1 (5.2%). Overall mortality was 2.9% (n=55). A higher incidence of rejection (mostly ACR) was noted in the high EMB group compared to low EMB (20.8% vs 3.7%, p<0.001); as well as high HC vs. low HC cohort (13.5% vs. 9.2%, p=0.04) and survival after 1 year was similar across groups (Figure 1A and 1B). This analysis highlights the varied surveillance practices across US hospitals. Higher levels of surveillance were associated with more frequent clinical outcomes when compared to lower surveillance in the first year post HT, which may be a reflection of a higher risk patient population. Further work is necessary to elucidate a preferred method and frequency of HT surveillance." @default.
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• W4362580218 date "2023-04-01" @default.
• W4362580218 modified "2023-09-28" @default.
• W4362580218 title "(558) Impact of Rejection Surveillance Practices on Outcomes after Heart Transplantation" @default.
• W4362580218 doi "https://doi.org/10.1016/j.healun.2023.02.573" @default.
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