The Combined Use of Gene Expression Profile and Donor-Derived Cell-Free DNA Testing in the Management of Heart Transplant Patients: The Mid America Experience
| Autor: | Andrew Kao, D. Vodnala, Anthony Magalski, A.M. Borkon, Michael E. Nassif, Bethany A. Austin, Taiyeb M. Khumri, Timothy J. Fendler, Brett W. Sperry, Mark P. Everley, J. Linard, S.L. Lawhorn |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Transplantation medicine.medical_specialty business.industry Combined use Lower risk Predictive value Post transplant Cell-free fetal DNA Prednisone Internal medicine Medicine Surgery Transplant patient Donor derived Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | The Journal of Heart and Lung Transplantation. 39:S253-S254 |
| ISSN: | 1053-2498 |
| DOI: | 10.1016/j.healun.2020.01.549 |
| Popis: | Purpose Gene expression profile (GEP) testing has a high negative predictive value for Methods dd-cfDNA was drawn beginning at 2 mos post transplant and GEP was drawn at 2 mos or 30 days post prednisone wean Results Between 2/11-10/4/19, 121 pts (54.8±12.9 yrs; 79% men) between 2 mos-3 yrs post transplant had 324 visits with both GEP/dd-cfDNA. Table shows distribution of results. Only 6% were above threshold for both. This led to an additional 12 (60%) EMBs. 20% had positive GEP with negative dd-cfDNA (which would have led to an EMB without dd-cfDNA), EMB was cancelled for 46 (70%) of these visits. 8% of visits had only dd-cfDNA elevation. 13 (52%) of these had EMBs, but 10 (40%) EMBs were cancelled in favor of repeating dd-cfDNA at the next visit. 66% had both tests negative and EMB was cancelled for 156 (73%) of these visits. With the use of dd-cfDNA, an additional 13 EMBs were performed with negative GEP but 46 EMBs were avoided due to dd-cfDNA being negative with a positive GEP. For visits starting at 6 mos, 84% of EMBs were cancelled due to combined testing. Without dd-cfDNA, only 73% EMBs would have been cancelled for negative GEP. Conclusion Adding dd-cfDNA to GEP testing helped reclassify some GEP positive only pts into a lower risk group with an additional 11% of EMBs cancelled. Further evaluation of the utility of the combined use of GEP and dd-cfDNA is warranted. |
| Databáze: | OpenAIRE |
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