Clinical Prediction Model for Antibody-Mediated Rejection: A Strategy to Minimize Surveillance Endomyocardial Biopsies After Heart Transplantation.

Humans Graft Rejection / diagnosis Models, Statistical Myocardium / pathology Retrospective Studies Heart Failure / pathology Prognosis Heart Transplantation / adverse effects Antibodies Biopsy
biopsy heart failure heart transplantation phenotype risk

Journal

Circulation. Heart failure
ISSN: 1941-3297
Titre abrégé: Circ Heart Fail
Pays: United States
ID NLM: 101479941

Informations de publication

Date de publication:
10 2022
Historique:
pubmed: 7 10 2022
medline: 21 10 2022
entrez: 6 10 2022
Statut: ppublish

Résumé

In heart transplantation, antibody-mediated rejection (AMR) is a major contributor to patient morbidity and mortality. Multiple routine endomyocardial biopsies (EMB) remain the gold standard to detect AMR, but this invasive procedure suffers from many limitations. We aimed to develop and validate an AMR risk model to improve individual risk stratification of AMR. Heart recipients from 2 referral transplant centers, Cedars-Sinai (US) and Pitié-Salpêtrière (France), were included from 2012 to 2019. Database included detailed clinical, immunologic, imaging, and histological parameters. The US cohort was randomly distributed in a derivation (2/3) and in a test set (1/3). The primary end point was biopsy-proven AMR. A mixed effect logistic regression model with a random intercept was applied to identify variables independently associated with AMR. Simulation analyzes were performed. The US and French cohorts comprised a total of 1341 patients, representing 12 864 EMB. Overall, 490 AMR episodes were diagnosed (3.8% of EMB). Among the 26 potential determinants of AMR, 5 variables showed independent association: time post-transplant ( Our results support the use of the AMR risk model as a clinical decision tool to minimize the number of routine EMB after heart transplantation.

Sections du résumé

BACKGROUND
In heart transplantation, antibody-mediated rejection (AMR) is a major contributor to patient morbidity and mortality. Multiple routine endomyocardial biopsies (EMB) remain the gold standard to detect AMR, but this invasive procedure suffers from many limitations. We aimed to develop and validate an AMR risk model to improve individual risk stratification of AMR.
METHODS
Heart recipients from 2 referral transplant centers, Cedars-Sinai (US) and Pitié-Salpêtrière (France), were included from 2012 to 2019. Database included detailed clinical, immunologic, imaging, and histological parameters. The US cohort was randomly distributed in a derivation (2/3) and in a test set (1/3). The primary end point was biopsy-proven AMR. A mixed effect logistic regression model with a random intercept was applied to identify variables independently associated with AMR. Simulation analyzes were performed.
RESULTS
The US and French cohorts comprised a total of 1341 patients, representing 12 864 EMB. Overall, 490 AMR episodes were diagnosed (3.8% of EMB). Among the 26 potential determinants of AMR, 5 variables showed independent association: time post-transplant (
CONCLUSIONS
Our results support the use of the AMR risk model as a clinical decision tool to minimize the number of routine EMB after heart transplantation.

Identifiants

DOI: 10.1161/CIRCHEARTFAILURE.122.009923 PMID: 36200456
pubmed: 36200456
doi: 10.1161/CIRCHEARTFAILURE.122.009923
doi:

Substances chimiques

Antibodies 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e009923

Auteurs

Guillaume Coutance (G)

University of Paris, Institut National de la Santé et de la Recherche Médicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.).
Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University Medical School, Paris, France (G.C., P.L., S.V.).
ORCID: 0000-0003-4939-2175

Evan Kransdorf (E)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.K., J.K., P.B.).
ORCID: 0000-0002-0507-2412

Olivier Aubert (O)

University of Paris, Institut National de la Santé et de la Recherche Médicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.).
Kidney Transplant Department, Hôpital Necker, AP-HP, Paris, France (O.A., A.L.).

Guillaume Bonnet (G)

University of Paris, Institut National de la Santé et de la Recherche Médicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.).
ORCID: 0000-0002-3027-1771

Daniel Yoo (D)

University of Paris, Institut National de la Santé et de la Recherche Médicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.).

Philippe Rouvier (P)

Pathology Department, La Pitié Salpétrière, AP-HP, Paris, France (P.R.).
ORCID: 0000-0003-2198-251X

Jean-Paul Duong Van Huyen (JP)

Pathology Department, Hôpital Necker, AP-HP and Université de Paris, Paris, France (J.-P.D.V.H.).

Patrick Bruneval (P)

University of Paris, Institut National de la Santé et de la Recherche Médicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.).
Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.K., J.K., P.B.).

Jean-Luc Taupin (JL)

Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, AP-HP, Paris, France (J.-L.T.).

Pascal Leprince (P)

Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University Medical School, Paris, France (G.C., P.L., S.V.).

Shaida Varnous (S)

Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University Medical School, Paris, France (G.C., P.L., S.V.).

Jon Kobashigawa (J)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.K., J.K., P.B.).

Xavier Jouven (X)

University of Paris, Institut National de la Santé et de la Recherche Médicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.).
Cardiology and Heart Transplant Department, Hôpital Pompidou, AP-HP, Paris, France (X.J.).

Jignesh Patel (J)

ORCID: 0000-0003-0618-6750

Alexandre Loupy (A)

University of Paris, Institut National de la Santé et de la Recherche Médicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.).
Kidney Transplant Department, Hôpital Necker, AP-HP, Paris, France (O.A., A.L.).
ORCID: 0000-0003-3388-7747

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Classifications MeSH

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questionsmedicales.fr › Phénomènes du système immunitaire › Immunologie en transplantation › Réaction de l'hôte contre le greffon › Rejet du greffon › Clinical Prediction Model for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Modèles statistiques › Clinical Prediction Model for...
questionsmedicales.fr › Tissus › Muscles › Muscle strié › Myocarde › Clinical Prediction Model for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Clinical Prediction Model for...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Défaillance cardiaque › Clinical Prediction Model for...
questionsmedicales.fr › Diagnostic › Pronostic › Clinical Prediction Model for...
questionsmedicales.fr › Procédures de chirurgie opératoire › Transplantation › Transplantation d'organe › Transplantation cardiaque › Clinical Prediction Model for...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Globulines › Sérum-globulines › Immunoglobulines › Anticorps › Clinical Prediction Model for...
questionsmedicales.fr › Techniques d'investigation › Techniques cytologiques › Cytodiagnostic › Biopsie › Clinical Prediction Model for...