Three-year outcomes with the use of dual non-invasive rejection surveillance after heart transplantation.

Abstract

Donor-derived cell-free DNA (ddcfDNA) and gene expression profiling (GEP) allow for non-invasive monitoring of rejection after heart transplantation in place of endomyocardial biopsies (EMBx). However, data are limited on the impact this strategy has on heart transplant graft outcomes after 2 years post transplant.This is a single center, retrospective analysis of adult heart transplant recipients, comparing a rejection surveillance cohort of GEP/biopsy (1/2015-12/2017) against a rejection surveillance cohort of GEP/ddcfDNA (7/2018-12/2020). The primary outcome was survival at 3 years post transplant. Secondary outcomes included ejection fraction (EF), rejection free survival, total number of EMBx in follow-up period, and development of de novo donor specific antibodies (dnDSA).A total of 88 patients in the GEP/Biopsy cohort and 90 patients in the GEP/ddcfDNA cohort were included in the analysis. When comparing GEP/Biopsy against GEP/ddcfDNA, overall survival (85.2% vs. 86.7%, p=0.78). Biopsy proven acute cellular rejection (70.5% vs 83.3%, p = 0.062), biopsy proven antibody mediated rejection (97.7 vs. 94.5%, p = 0.26), LVEF at 3 years [60.3 (57.9-63.6) vs. 60.3 (57.5-63.1], and development of dnDSA [34/88 (38.6%) vs. 36/91 (39.6%), p = 1.0] when comparing GEP/biopsy against GEP/ddcfDNA, indicating similar clinical outcomes. However, patients in the GEP/ddcfDNA had fewer biopsies [4 (3-6) vs. 12 (10-14), p<0.001)].When comparing a rejection surveillance strategy of GEP/biopsy against GEP/ddcfDNA, heart transplant outcomes were similar at 3 years, while a strategy of GEP/ddcfDNA resulted in significantly fewer EMBx.

View details for DOI 10.1016/j.jhlto.2025.100456

View details for PubMedID 41541417

View details for PubMedCentralID PMC12799936