Gene-Expression Profiling for Rejection Surveillance after Cardiac Transplantation
In: The New England journal of medicine, Jg. 362 (2010), Heft 20, S. 1890-1900
academicJournal
- print, 22 ref
Zugriff:
BACKGROUND Endomyocardial biopsy is the standard method of monitoring for rejection in recipients of a cardiac transplant. However, this procedure is uncomfortable, and there are risks associated with it. Gene-expression profiling of peripheral-blood specimens has been shown to correlate with the results of an endomyocardial biopsy. METHODS We randomly assigned 602 patients who had undergone cardiac transplantation 6 months to 5 years previously to be monitored for rejection with the use of gene-expression profiling or with the use of routine endomyocardial biopsies, in addition to clinical and echocardiographic assessment of graft function. We performed a noninferiority comparison of the two approaches with respect to the composite primary outcome of rejection with hemodynamic compromise, graft dysfunction due to other causes, death, or retransplantation. RESULTS During a median follow-up period of 19 months, patients who were monitored with gene-expression profiling and those who underwent routine biopsies had similar 2-year cumulative rates of the composite primary outcome (14.5% and 15.3%, respectively ; hazard ratio with gene-expression profiling, 1.04; 95% confidence interval, 0.67 to 1.68). The 2-year rates of death from any cause were also similar in the two groups (6.3% and 5.5%, respectively; P=0.82). Patients who were monitored with the use of gene-expression profiling underwent fewer biopsies per person-year of follow-up than did patients who were monitored with the use of endomyocardial biopsies (0.5 vs. 3.0, P<0.001). CONCLUSIONS Among selected patients who had received a cardiac transplant more than 6 months previously and who were at a low risk for rejection, a strategy of monitoring for rejection that involved gene-expression profiling, as compared with routine biopsies, was not associated with an increased risk of serious adverse outcomes and resulted in the performance of significantly fewer biopsies.
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Gene-Expression Profiling for Rejection Surveillance after Cardiac Transplantation
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Autor/in / Beteiligte Person: | PHAM, Michael X ; TEUTEBERG, Jeffrey J ; BARAN, David A ; BOGAEV, Roberta C ; ELASHOFF, Barbara ; BARON, Helen ; YEE, James ; VALANTINE, Hannah A ; KFOURY, Abdallah G ; STARLING, Randall C ; DENG, Mario C ; CAPPOLA, Thomas P ; KAO, Andrew ; ANDERSON, Allen S ; COTTS, William G ; EWALD, Gregory A ; IMAGE Study Group |
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Zeitschrift: | The New England journal of medicine, Jg. 362 (2010), Heft 20, S. 1890-1900 |
Veröffentlichung: | Waltham, MA: Massachusetts Medical Society, 2010 |
Medientyp: | academicJournal |
Umfang: | print, 22 ref |
ISSN: | 0028-4793 (print) |
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