The findings from a study of a new blood test offering a less invasive approach and earlier detection of acute heart transplant rejection were published in the March 23 issue of Circulation, a journal of the American Heart Association. The article is based on a study co-authored by Palak Shah, MD, MS, an Inova Heart and Vascular Institute heart failure and transplant specialist.
Dr. Shah, a board-certified cardiologist who also serves as Director of Inova’s Cardiovascular Genomics Center and Medical Director for Mechanical Circulatory Support within Inova’s Heart Failure and Transplant Program, was integral to the development, design and execution of the study.
The study was primarily funded by the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health. The research team also included Sean Agbor-Enoh, MD, PhD, study co-author and Chief of the Laboratory of Applied Precision Omics at NHLBI, and Hannah Valantine, MD, senior study author and former Lead Investigator of the Laboratory of Organ Transplant Genomics in the Cardiovascular Branch at the NHLBI.
The study describes a DNA-based blood test to detect acute heart transplant rejection weeks to months before current clinical tools. This enables physicians to prevent or slow down this potentially deadly condition that occurs most commonly in the early months after a patient has received a donor heart.
The new test performed better than tissue biopsies, the current practice, among the nearly 200 patients involved in the study by signaling problems even when there were no outward signs of rejection. The patients had recently undergone heart transplantation at one of five regional transplant centers in the Washington, DC region, including Inova’s Heart Failure and Transplant Program, which performed more than 40 heart transplants in 2020.
Acute transplant rejection generally occurs in the first six months after transplant, while chronic rejection occurs after many years. Current tests for acute rejection rely on frequent and painful biopsies of heart tissue that run the risk of damaging the heart and are less reliable.
According to the researchers, the new blood test may be able to detect rejection as early as 28 days after transplant and, in some circumstances, three months before rejection is detectable using biopsies. In addition, while heart biopsies are only performed in hospitals, specimens for the new blood test can be collected in a patient’s home, making the procedure more convenient and less expensive.
“This test, if clinically implemented, can safely eliminate about 80 percent of the biopsies currently performed after heart transplant,” said Dr. Shah. “If future studies prove its safety and efficacy, it could become a routine tool used to monitor heart transplant patients for rejection.”
Researchers also believe the new test is important for addressing heath disparities, because African Americans have higher rates of heart transplant rejection and poorer outcomes than other groups nationwide. The study population included a high percentage (about 44 percent) of African Americans. The new test facilitates further study of the mechanisms underlying rejection and could, therefore, help eliminate these disparities.
For more information about Inova Heart and Vascular Institute’s heart transplant program, visit https://www.inovaheart.org/heart-care/heart-transplant
Link to abstract: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.049098