Abstract 17511: Use of Gene Expression Profiling is Associated With Reduced Incidence of Moderate to Severe Tricuspid Regurgitation Post Heart Transplant: The Mid America Experience
Introduction: Moderate to severe tricuspid regurgitation (TR) post orthotopic heart transplant (OHT) is associated with poor long-term outcomes.
Hypothesis: Noninvasive surveillance of allograft rejection via gene expression profiling (GEP) may reduce the incidence of TR post OHT.
Methods: Endomyocardial biopsies (EMB) were performed from 1 wk to 3 yrs post OHT according to protocol (qwk x4, q2wks x2, qmo x10, q3mos x4, q6mos x2). TR was graded 0 to 4+. Pts were dichotomized into those with 0-2+ TR throughout the post-OHT period or those with 3-4+ TR at any time post-OHT. Pts with TR prior to their first EMB were censored from the time-dependent covariate analysis.
Results: 464 OHT were performed in 459 pts (mean age 49.8±12.7 yrs; 22.9% women; 36.8% ischemic cardiomyopathy) at our institution between 1/1/00 and 7/1/15. 455 pts with ≥1 post-OHT echo were included in this retrospective study. 91% had preemptive tricuspid annuloplasty (TA) at time of OHT. GEP testing began 4-6 mos post-OHT in 295/455 pts. In a multivariable Cox model, GEP use was associated with a significant reduction in EMB performed (HR 0.48; 95% CI: 0.44,0.52; p<0.0001). The forest plot below reveals that increasing donor age (HR=1.17 per 5 yrs; 95% CI: 1.06,1.28; p<0.001) and female donor-male recipient (HR=1.78; 95% CI: 1.09,2.91; p<0.02) were significantly associated with developing 3-4+TR; whereas TA at time of OHT (HR=0.29; 95% CI: 0.15,0.55; p<0.0002) and GEP use (HR=0.27; 95% CI: 0.13,0.55; p<0.0003) were significantly associated with reduced risk of 3-4+ TR. Cumulative number of EMB was significantly and linearly associated with developing 3-4+ TR (HR=1.11 per EMB; 95% CI: 1.03,1.19; p<0.005).
Conclusion: This study revealed that the number of EMB is associated with a linear increase in risk of developing 3-4+TR. The use of GEP initiated by 6 mos post OHT is significantly associated with reduced number of EMB and risk of 3-4+TR. Larger prospective studies are needed to confirm these intriguing findings.
Author Disclosures: K. Carl: None. A. Kao: None. B. Austin: None. M. Everley: None. T. Khumri: None. S. Lawhorn: None. A. Magalski: None. S. Aggarwal: None. P. Jones: None. A.M. Borkon: None.
- © 2016 by American Heart Association, Inc.