Carey Sandra A, Tecson Kristen M, Jamil Aayla K, Felius Joost, Wolf-Doty Theresa K, Hall Shelley A
Center for Advanced Heart and Lung Disease, Baylor University Medical Center, 3410 Worth St., Suite 250, Dallas, TX 75246, USA; Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, 3410 Worth St., Suite 560, Dallas, TX 75246, USA.
Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, 621 Hall St., Dallas, TX 75246, USA.
Transpl Immunol. 2018 Aug;49:28-32. doi: 10.1016/j.trim.2018.03.003. Epub 2018 Mar 26.
Serial gene expression profiling (GEP) may reduce the need for endomyocardial biopsies for detecting acute cellular rejection (ACR) after transplantation, but its performance in dual organ transplant recipients is currently unknown.
We analyzed 18 months of follow-up in a national cohort of 27 dual organ recipients (18 heart-kidney, 8 heart-liver, 1 heart-lung) matched to 54 heart-only recipients for gender, age, and time to first GEP (AlloMap®) test. ACR, antibody-mediated rejection (AMR), cytomegalovirus infections, biopsies, and longitudinal GEP scores were evaluated.
During the first 90 days post-transplant, the mean GEP score for dual organ recipients was 25.2 ± 9.1, vs. 23.5 ± 7.7 for heart-only recipients (P = 0.48), with final GEP scores being 29.1 ± 6.1 and 32.3 ± 3.4, respectively (P = 0.34). GEP scores increased over time (P < 0.001) at a similar rate (P = 0.33) for both groups. One heart-only recipient had treated ACR (GEP score = 17). Fourteen subjects had cytomegalovirus infection, 8 of whom were dual-organ. During follow-up, mean GEP score among patients with cytomegalovirus infection was 32.3, compared to 26.7 (p < 0.001) in patients without cytomegalovirus. Only 4 (2%) of 233 biopsies were positive for mild AMR; all occurring in 2 heart-only recipients (GEP scores = 18-33).
This largest cohort to date suggests that dual organ transplantation alone should not be reason to omit GEP testing from post-transplant medical management, as the two groups' scores did not differ significantly. Confirming that GEP scores increase over time for heart-only and dual organ recipients and in the presence of cytomegalovirus infection, our work shows promise for the use of serial GEP testing in dual organ recipients.
连续基因表达谱分析（GEP）可能会减少移植后检测急性细胞排斥反应（ACR）时心内膜心肌活检的需求，但目前其在双器官移植受者中的表现尚不清楚。
我们分析了全国27名双器官移植受者（18例心脏-肾脏、8例心脏-肝脏、1例心脏-肺）队列的18个月随访情况，这些受者在性别、年龄和首次GEP（AlloMap®）检测时间方面与54名单纯心脏移植受者相匹配。对ACR、抗体介导的排斥反应（AMR）、巨细胞病毒感染、活检以及纵向GEP评分进行了评估。
在移植后的前90天，双器官移植受者的平均GEP评分为25.2±9.1，而单纯心脏移植受者为23.5±7.7（P = 0.48），最终GEP评分分别为29.1±6.1和32.3±3.4（P = 0.34）。两组的GEP评分均随时间增加（P < 0.001），且增加速率相似（P = 0.33）。1名单纯心脏移植受者接受了ACR治疗（GEP评分 = 17）。14名受试者发生了巨细胞病毒感染，其中8名是双器官移植受者。在随访期间，巨细胞病毒感染患者的平均GEP评分为32.3，而未感染巨细胞病毒的患者为26.7（p < 0.001）。233次活检中只有4次（2%）轻度AMR呈阳性；均发生在2名单纯心脏移植受者中（GEP评分 = 18 - 33）。
这个迄今为止最大的队列表明，仅双器官移植本身不应成为在移植后医疗管理中省略GEP检测的理由，因为两组评分无显著差异。我们的研究证实了单纯心脏移植受者和双器官移植受者的GEP评分均随时间增加，且在存在巨细胞病毒感染时也是如此，这表明连续GEP检测在双器官移植受者中的应用具有前景。
