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Predictive value of gene expression profiling for long-term survival after heart transplantation
Buntaro Fujita1, Emir Prashovikj1, Uwe Schulz1
1Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
Insights
Changes in the AlloMap® gene expression test after heart transplantation (HT) can predict long-term survival. An increasing AlloMap® score indicates higher mortality risk, offering a potential tool for patient risk stratification.
Area of Science:
- Cardiology
- Immunology
- Genomics
Background:
- Long-term survival after heart transplantation (HT) is difficult to predict.
- Gene expression profiling may offer insights into post-transplant outcomes.
Purpose of the Study:
- To determine if the AlloMap® gene expression test correlates with long-term survival after heart transplantation.
- To assess the predictive value of AlloMap® score dynamics for mortality risk.
Main Methods:
- Analysis of 46 heart transplant recipients from the CARGO II trial.
- Patients categorized based on AlloMap® score changes between 6 and 9 months post-HT.
- Primary endpoint: long-term all-cause mortality.
Main Results:
- An increasing AlloMap® score was linked to significantly elevated long-term all-cause mortality (log-rank p=0.005).
- A 9-month to 6-month AlloMap® ratio ≤1.02 demonstrated 100% negative predictive value for mortality.
- Median follow-up was 8.1 years.
Conclusions:
- Dynamic AlloMap® score changes between 6 and 9 months post-HT are strongly associated with long-term survival.
- AlloMap® may serve as a valuable tool for estimating long-term mortality risk in heart transplant patients.
Objectives:
Identifying patients at risk for impaired long-term survival after heart transplantation (HT) remains a clinical challenge. The aim of this analysis was to investigate whether the gene expression profiling test AlloMap® is related to long-term survival after HT.
Methods:
46 patients who underwent HT between 2006 and 2007 who were originally included into the CARGO II trial at our institution were investigated. Patients were divided in two groups according to an increase or decrease of the AlloMap® score between 6 and 9months after HT. The primary endpoint of this study was long-term all-cause mortality.
Results:
23 patients showed an increase of the AlloMap® score between 6 and 9months after HT whereas the remaining 23 patients presented with a decrease of the score. After a median follow-up time of 8.1years (interquartile range 7.6-8.6), all-cause mortality was significantly elevated in patients with an AlloMap® increase compared with patients who showed a decrease of the score (log-rank p=0.005). A ratio of the AlloMap® at 9months to 6months of 1.02 or less was associated with a negative predictive value for all-cause mortality of 100%.
Conclusions:
Dynamic changes of the AlloMap® score between 6 and 9months after HT were strongly related to all-cause long-term survival after HT. These results suggest that AlloMap® potentially displays a useful tool to estimate the patients' risk for long-term mortality.
