Abstract
Dev and Lloyd-Jones address an important challenge of implementing gene-expression-profiling-based heart transplant rejection monitoring as introduced by our multimember study group in the US. However, their arguments suffer from conceptual misunderstandings and spurious assumptions prompting our response to clarify the perspective of the paradigm transition to noninvasive monitoring in heart transplant recipients. 1 Starling R.C. Pham M. Valantine H. et al. Molecular testing in the management of cardiac transplant recipients: initial clinical experience. J Heart Lung Transplant. 2006; 25: 1389-1395 Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar , 2 Deng M.C. Eisen H.J. Mehra M.R. Billingham M. Marboe C.C. Berry G. Kobashigawa J. Johnson F.L. Starling R.C. Murali S. et al. Noninvasive discrimination of rejection in cardiac allograft recipients using gene expression profiling. Am J Transplant. 2006; 6: 150-160 Crossref PubMed Scopus (415) Google Scholar Conceptually, the non-invasive algorithm proposed by us has to be compared to existing standards of practice including: (a) invasive biopsy-based monitoring for lifetime with gradually increasing intervals; or (b) non-invasive monitoring to assess graft function, after the cessation of biopsy based monitoring, a practice which is highly variable in the United States. 3 Stehlik J. Starling R.C. Movsesian M.A. et al. Utility of long-term surveillance endomyocardial biopsy: a multi-institutional analysis. J Heart Lung Transplant. 2006; 25: 1402-1409 Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar Problems Associated with Screening for Asymptomatic Cardiac Transplant RejectionThe Journal of Heart and Lung TransplantationVol. 26Issue 11PreviewThe review of the gene expression profiling (GEP) experience by Starling et al1 highlights some of the difficulties in designing a screening test for a low-prevalence condition of unclear clinical significance, that is, asymptomatic cardiac rejection. From Table 1 of their study we can develop a 2 × 2 table to determine the prevalence of Grade ≥3a rejection as well as the number of true/false positives and negatives from the CARGO population.2 Full-Text PDF
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