Efficacy of Genetic Profile Testing Using Allomap® in Combined Heart-Kidney Transplant Recipients

Abstract

BackgroundThe recently published Image Trial in the New England Journal of Medicine noted the Allomap® test to have similar efficacy compared to invasive endomyocardial biopsy (RVBX) for immune surveillance of acute cellular rejection in low risk adult primary cardiac transplant recipients. However, the efficacy of Allomap® in combined heart kidney recipients is unknown.MethodsWe retrospectively evaluated 7 combined heart-kidney transplant recipients (6 males with 1 redo cardiac transplant recipient and 4 patients supported with Syncardia Total Artificial Heart). We performed protocol serial Allomap® testing at 3, 4, 6, 8 and 10 months post transplant as well as protocol RVBX's. As per our previously reported experience, we performed RVBx when Allomap® score ≥32.ResultsTabled 1Allomap Scores in Combined Heart-Kidney RecipientsValue3 Months4 Months6 Months8 Months10 MonthsAverage1027283638Standard Deviation1.278.82.61 Open table in a new tab InferencesOur findings suggest that combined heart-kidney recipients may in fact turn on or off key genetic factors giving rise to markedly elevated Allomap® scores. These elevated scores don't appear to be a signal for either acute cellular rejection or humoral rejection at the previously adjudicated values although our sample size is too small to say that with certainty. Clearly more needs to be done to clarify this intriguing observation. BackgroundThe recently published Image Trial in the New England Journal of Medicine noted the Allomap® test to have similar efficacy compared to invasive endomyocardial biopsy (RVBX) for immune surveillance of acute cellular rejection in low risk adult primary cardiac transplant recipients. However, the efficacy of Allomap® in combined heart kidney recipients is unknown. The recently published Image Trial in the New England Journal of Medicine noted the Allomap® test to have similar efficacy compared to invasive endomyocardial biopsy (RVBX) for immune surveillance of acute cellular rejection in low risk adult primary cardiac transplant recipients. However, the efficacy of Allomap® in combined heart kidney recipients is unknown. MethodsWe retrospectively evaluated 7 combined heart-kidney transplant recipients (6 males with 1 redo cardiac transplant recipient and 4 patients supported with Syncardia Total Artificial Heart). We performed protocol serial Allomap® testing at 3, 4, 6, 8 and 10 months post transplant as well as protocol RVBX's. As per our previously reported experience, we performed RVBx when Allomap® score ≥32. We retrospectively evaluated 7 combined heart-kidney transplant recipients (6 males with 1 redo cardiac transplant recipient and 4 patients supported with Syncardia Total Artificial Heart). We performed protocol serial Allomap® testing at 3, 4, 6, 8 and 10 months post transplant as well as protocol RVBX's. As per our previously reported experience, we performed RVBx when Allomap® score ≥32. ResultsTabled 1Allomap Scores in Combined Heart-Kidney RecipientsValue3 Months4 Months6 Months8 Months10 MonthsAverage1027283638Standard Deviation1.278.82.61 Open table in a new tab InferencesOur findings suggest that combined heart-kidney recipients may in fact turn on or off key genetic factors giving rise to markedly elevated Allomap® scores. These elevated scores don't appear to be a signal for either acute cellular rejection or humoral rejection at the previously adjudicated values although our sample size is too small to say that with certainty. Clearly more needs to be done to clarify this intriguing observation. Our findings suggest that combined heart-kidney recipients may in fact turn on or off key genetic factors giving rise to markedly elevated Allomap® scores. These elevated scores don't appear to be a signal for either acute cellular rejection or humoral rejection at the previously adjudicated values although our sample size is too small to say that with certainty. Clearly more needs to be done to clarify this intriguing observation.