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MOTR : Use of dd-cfDNA in multi-organ transplant rejection detection ( MOTR ) With dd-cfDNA rapidly becoming a more widely used method of monitoring for organ rejection , this study seeks to better understand the ability of ddcfDNA to detect rejection in multi-organ transplant patients . The site has we enrolled 26 recipients of a heart-kidney dual organ transplant . Principal investigator : Timothy Gong , MD , FACC .
ProTECT : Prospera Test Evaluation in Cardiac Transplant ( ProTECT ) Prospera is a commercially available test for noninvasive detection of allograft rejection and with high accuracy by measuring the fraction of ddcfDNA in the patient ’ s blood , without the need for prior donor or recipient genotyping . The ProTECT registry is an observational longitudinal , multicenter study observing patients undergoing heart transplant for whom Prospera testing is part of routine clinical care . Twenty-eight patients have been enrolled at Baylor Dallas . Principal investigator : Shelley Hall , MD , FACC , FHFSA , FAST .
Key publications FY22
van Zyl JS , Sam T , Clark D , Felius J , Doss A , Kerlee K , Cheung Z , Martits-Chalangari K , Jamil A , Carey S , Gottlieb R , Guerrero-Miranda C , Kale P , Hall S . Denovo tacrolimus extended-release tablets ( LCPT ) vs twice-daily tacrolimus in adult heart transplantation : Results of a single-center non-inferiority matched control trial . Clinical Transplantation 2021 ; 35 ( 12 ) e14487 .
Optimizing immunosuppressive regimens in patients following heart transplantation is of vital importance in this population . The study compared outcomes in 25 patients receiving once-daily extended-release dosing of tacrolimus to the more conventional twice-daily immediate-release formulation . The results suggest the extended release regimen is non-inferior in efficiency to the immediate release formulation with similar complication rates , while cardiovascular-related hospital readmissions were reduced .
Afzal , A , Alam A , van Zyl JS , Zafar H , Felius J , Hall S , Carey S . Observed elevated donor-derived cell free DNA in orthotopic heart transplant recipients without clinical evidence of rejection . Clinical Transplantation 2022 ; 36 ( 3 ) e14549 .
A major advantage of donor-derived cell free DNA ( dd-cfDNA ) testing over other modalities is that it is a non-invasive procedure . However , it has a high negative predictive value with only modest positive predictive value , making it a rule-out test . The article sought to provide a better understanding of positive dd-cfDNA results in the absence of rejection by studying a case series of more than 100 patients . Statistical cluster analysis revealed CMV and non- CMV infections , right ventricular dysfunction , and female sex of relatively young age to all play a potential role .
Alam A , van Zyl JS , Milligan GP , McKean SM , Patel R , Hall S . Evolving the surveillance and workup of heart transplant rejection : a real-world analysis of the Molecular Microscope Diagnostic System . American Journal of Transplantation , 2022 in press .
The Molecular Microscope Diagnostic System ( MMDx ) is the latest and most sophisticated method of monitoring for organ transplant rejection . It analyzes RNA transcripts of transplanted tissue to differentiate amongst T-cell mediated rejection ( TCMR ), antibody mediated rejection ( AMR ), injury and healthy tissue . In the heart transplant world , much has yet to be done to assess the performance of MMDx relative to other methods . This article presents the first direct comparison of MMDx results with cell-free DNA and endomyocardial biopsy test results , providing novel insights not only about the level of agreement among these methods but also about systematic differences , thus highlighting the value of using multiple test modalities .
Baylor Scott & White Heart and Vascular Hospital - Dallas | Heart Transplantation