Clinical Prediction Model for Antibody-Mediated Rejection: A Strategy to Minimize Surveillance Endomyocardial Biopsies After Heart Transplantation

Autor: Guillaume Coutance, Evan Kransdorf, Olivier Aubert, Guillaume Bonnet, Daniel Yoo, Philippe Rouvier, Jean-Paul Duong Van Huyen, Patrick Bruneval, Jean-Luc Taupin, Pascal Leprince, Shaida Varnous, Jon Kobashigawa, Xavier Jouven, Jignesh Patel, Alexandre Loupy
Rok vydání: 2022
Předmět:
Zdroj: Circulation: Heart Failure. 15
ISSN: 1941-3297
1941-3289
DOI: 10.1161/circheartfailure.122.009923
Popis: Background: In heart transplantation, antibody-mediated rejection (AMR) is a major contributor to patient morbidity and mortality. Multiple routine endomyocardial biopsies (EMB) remain the gold standard to detect AMR, but this invasive procedure suffers from many limitations. We aimed to develop and validate an AMR risk model to improve individual risk stratification of AMR. Methods: Heart recipients from 2 referral transplant centers, Cedars-Sinai (US) and Pitié-Salpêtrière (France), were included from 2012 to 2019. Database included detailed clinical, immunologic, imaging, and histological parameters. The US cohort was randomly distributed in a derivation (2/3) and in a test set (1/3). The primary end point was biopsy-proven AMR. A mixed effect logistic regression model with a random intercept was applied to identify variables independently associated with AMR. Simulation analyzes were performed. Results: The US and French cohorts comprised a total of 1341 patients, representing 12 864 EMB. Overall, 490 AMR episodes were diagnosed (3.8% of EMB). Among the 26 potential determinants of AMR, 5 variables showed independent association: time post-transplant ( P P =0.001), circulating donor-specific anti–human leukocyte antigen antibody ( P =0.001), graft dysfunction ( P =0.004), and prior history of definite AMR ( P Conclusions: Our results support the use of the AMR risk model as a clinical decision tool to minimize the number of routine EMB after heart transplantation.
Databáze: OpenAIRE
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