Abstract
Introduction: Little is known about the relationship between active viral infections and donor-derived cell free DNA (dd-cfDNA) levels in patients following heart transplantation. Methods: Paired respiratory viral panel, cytomegalovirus (CMV) or other for-cause viral studies and dd-cfDNA (AlloSure) results were prospectively collected on single-organ heart transplant recipients enrolled between August 2022 and March 2023. The levels of dd-cfDNA were compared between patients with positive and negative viral results at enrollment. Results: Of 44 patients enrolled, 18 tested positive with viral infections. Baseline characteristics were comparable between groups (median age 61 years, 73% male). The median time post-transplant was 289 days in patients with viral infections and 126 days in those without infections (p=0.046). None of the patients had concerns for concomitant rejection or graft dysfunction at time of their viral infection. Viral infection cases included 10 CMV, 1 Hepatitis-B and CMV, 3 Epstein-Barr virus (EBV), 2 Influenza, 1 Respiratory Syncytial virus (RSV), and 1 Coronavirus-19. Allomap gene-expression profile scores were similar between groups (p=0.15); whereas dd-cfDNA levels were significantly higher in patients with viral infections compared to controls (p=0.002). Table 1, Figure 1 Conclusion: Active viral infections can raise the level of dd-cfDNA levels in patients following heart transplantation. Further studies are needed to validate these preliminary findings.
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