Keskeiset käsitteet
Transitioning to noninvasive surveillance strategies for heart transplant rejection requires careful consideration and practical guidance.
Tiivistelmä
The content provides guidance on transitioning to noninvasive surveillance strategies for heart transplant rejection after relying on invasive methods like Endomyocardial biopsy (EMB). Key points include the correlation between circulating dd-cfDNA levels and rejection, the use of gene expression profiling (GEP) to reduce EMB frequency, challenges in interpretation, and the importance of considering various factors in implementing noninvasive surveillance. The content also discusses the timing of testing, the role of dd-cfDNA in detecting rejection types, and the challenges in implementing less invasive screening strategies.
Tilastot
Studies show that dd-cfDNA has a negative predictive value of 97% for acute cellular rejection and antibody-mediated rejection.
GEP reduces EMB use and is sensitive for detecting acute cellular rejection.
Levels of dd-cfDNA stabilize early at about 14 days post-transplant.
Routine testing is generally not recommended after 5 years post-transplant.
Lainaukset
"Elevated levels of dd-cfDNA over time are associated with adverse outcomes."
"Important to consider education of transplant faculty and staff on test interpretation."