IGTP Dataset: Table S1 and Table 2
Description
Introduction: Intragraft transcriptomic profiling (IGTP) testing has been introduced to more sensitively detect antibody-mediated rejection (ABMR or AMR) in heart transplant (HTx) patients. Although IGTP has been compared with other diagnostic modalities, its longitudinal description, associated clinical outcomes, and clinician utilization in molecular ABMR remain uncharacterized. Methods: The authors retrospectively analyzed 47 for-cause IGTP testing in 35 HTx patients at a single center. The primary objective was to evaluate whether IGTP-defined molecular ABMR predicted the clinical outcomes of cardiac allograft dysfunction and overall survival. Secondary analyses examined associations with donor-specific antibody (DSA), donor-derived cell-free DNA (dd-cfDNA), blood gene-expression profiling (GEP), and pathologic ABMR (pAMR) as defined by the International Society for Heart and Lung Transplantation (ISHLT). Results: IGTP testing identified molecular ABMR in 11 patients and no rejection or injury (NRI) in 24 patients. Median follow-up was 2.7 years. Molecular ABMR was significantly associated with DSA positivity (p = 0.040), elevated dd-cfDNA (p = 0.034), and the combined pAMR+/DSA+ class (p = 0.003), but not cardiac allograft dysfunction or overall survival. Among 6 treated patients, none showed resolution of molecular ABMR. Consequently, clinicians relied on clinical assessment, cardiac allograft dysfunction evaluation, DSA, dd-cfDNA, and blood GEP testing to guide longitudinal management. Conclusion: While IGTP-defined molecular ABMR was associated with positive DSA and elevated dd-cfDNA, it was not associated with clinical outcomes including cardiac allograft dysfunction and overall survival. Outcome-based, longitudinal studies are needed to determine how IGTP testing can complement current pAMR definitions and improve clinical decision making.
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Steps to reproduce
The authors retrospectively reviewed all clinically indicated intragraft transcriptomic profiling (IGTP) tests performed in heart transplant (HTx) recipients at UC San Diego Health. Data were collected from electronic medical records, including demographic characteristics, transplant history, molecular testing results, endomyocardial biopsy histopathology, donor-specific antibodies (DSA), donor-derived cell-free DNA (dd-cfDNA), gene-expression profiling (GEP), treatment decisions, and longitudinal clinical outcomes. Data were organized into two tables: Table S1 contains patient-level characteristics and clinical history, while Table 2 contains individual IGTP testing results and subsequent clinical outcomes.
Institutions
- UC San Diego Health SystemCalifornia, San Diego