Innovations in Rejection Surveillance after Heart Transplantation

Explore innovations in rejection surveillance following heart transplantation in this comprehensive lecture by Dr. Jon A. Kobashigawa. Delve into the evolution of heart transplant procedures, survival rates, and cutting-edge monitoring techniques. Learn about the IMAGE trial, cell-free DNA detection methods, and the limitations of traditional endomyocardial biopsies. Discover how molecular analysis and gene expression profiling are revolutionizing rejection diagnosis. Examine the Molecular Microscope Diagnostic system and its potential for improved risk stratification. Investigate the identification and characterization of cardiac allograft vasculopathy trajectories, including a multivariable analysis of determinants and an online calculator for clinical application.

Intro
Relevant Financial Relationship Disclosure Statement
Number of Adult and Pediatric Heart Transplants by Year and Location
Adult Heart Transplants Diagnosis
Adult Heart TransplantsKaplan-Meier Survival by Era
Innovations in Rejection Surveillance after Heart Transplantation
Invasive Monitoring Attenuation through Gene Expression (IMAGE) Trial
Combined Primary Endpoint
DNA the Molecule of Life
Cell-Free DNA (cfDNA) is Found in Circulating Blood
Cell-Free DNA to Detect Heart Allograft Acute Rejection Study
Longitudinal %ddcfDNA measures after transplant
biopsy graded rejection
Allograft dysfunction by echocardiography
What are the clinical implications?
Endomyocardial Biopsy (EMB)
Intrinsic Problems of the Current Pathology Approach to Diagnosis of Rejection
Common Histological Artefacts that Mimic Rejection
Intragraft mRNA Assessment of Rejection
How Molecular Analysis Works
The Molecular Landscape of Rejection: Using rejection associated transcripts as classifiers
Archetype Analysis
Comparing the A1,2,3 Archetypes for kidney, heart, and lung as estimated by expression of rejection-associated transcripts (RATs)
The INTERHEART Study
Updated rejection and Injury archetype diagnoses
Examples of Heart Transplant Endomyocardial Biopsy with updated MMDx-Heart Reports
Reconcile discrepancies: Injury Repair Response Associated Transcripts
MMDx Results according to ISHLT pathology grading (AMR)
¡Box system potential for risk stratification
Identification and Characterization of Trajectories of Cardiac Allograft Vasculopathy: Study design
Latent class mixed modelling
Baseline characteristics
Identification of 4 trajectories of CAV
Validation of the 4 trajectories in Europe and in the US
Determinants of trajectories: multivariable analysis
On-line calculator
Summary