Impact of Donor Characteristics on AlloSure Scores.

AlloSure dd-cfDNA (AS) has been demonstrated to detect allograft injury after heart transplantation in a large and diverse patient cohort in the United States, however, little is known about the association between donor and recipient characteristics and AS results in the early post-transplant period. A total of 2029 patients from the SHORE registry were analyzed. To evaluate the impact of donor/recipient variables on early post-transplant AS values, we compared clinically stable patients with and without persistent AS elevation during the first 6 months, specifically excluding those patients with clinical events (rejection, death, dnDSA, CAV and graft dysfunction, defined as LVEF < 40% or LVEF decline >= 25% between consecutive visits) during the 2-year study follow-up. Not all donor/recipient variables were available for every analysis performed. Among 767 patients meeting the inclusion criteria, we identified 82 patients with median scores >=0.15% during the first 6 months after transplant; the remaining 685 had median 6m AS scores <0.15% and were used as the comparator group. No differences were observed with regards to donor age, gender, cause of death, CMV status, or recipient variables including cPRA, induction therapy, HLA mismatches (A, B, C, DR, DQ loci), or need for pre-transplant mechanical support [Table 1]. Our investigation did not identify significant associations between donor/recipient variables and sustained elevations in AS in the early post-transplant period. Found in only a small minority of cohort patients (<5% of the SHORE registry), these elevations, suggestive of ongoing myocardial injury, may reflect the impact of immunologic variables not included in our analysis, such as the effect of and adherence to immunosuppressive therapy or the presence of low-level donor-specific antibodies. Further prospective studies are needed to better understand the etiologies and significance of these elevations. [ABSTRACT FROM AUTHOR]