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多模式分子测试为心脏移植接受者提供预后价值

Jeff Teuteberg¹, Snehal Patel², David A Baran³

¹Divison of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA.

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

|November 26, 2025

概括

双重阳性基因表达特征 (GEP) 和来自供体的无细胞DNA (dd-cfDNA) 测试预测心脏移植受体的移植功能障碍和心血管死亡. 这种多模式分子测试提供了超越组织学的预后信息.

科学领域:

心脏病学心脏病学
移植免疫学移植免疫学
分子诊断学分子诊断

背景情况:

多模式分子测试,包括基因表达特征 (GEP) 和来自捐赠者的无细胞DNA (dd-cfDNA),越来越多地用于心脏移植排斥监测.
关于GEP和dd-cfDNA对移植后未来临床事件的联合预测能力的数据有限.

研究的目的:

评估GEP和dd-cfDNA在预测心脏移植接受者的移植功能障碍 (GD) 和心血管 (CV) 死亡方面的联合能力.
评估结合GEP/dd-cfDNA结果的预后价值,以预测临床结果.

主要方法:

从监控心脏护理结果登记处分析了1934年心脏移植的接受者.
基于移植后2-6个月最异常的GEP/dd-cfDNA结果进行风险评估,以确定随后的12个月GD和心血管死亡发生率.
根据个体GEP/dd-cfDNA结果从移植后2个月到5年的30天GD和CV死亡发生率的评估.

主要成果:

双重阳性GEP/dd-cfDNA结果 (GEP+/dd-cfDNA+) 的患者在移植后2-6个月的一年内显示出GD或心血管死亡的最高发病率 (15.5%) (HR 1.59,p=0.017).
即使没有组织学拒绝证据,GEP+/dd-cfDNA+组与其他组相比,GD或心血管死亡的发病率 (14.6%) 更高 (5.1-8.7%,p=0.039).
与GEP-/dd-cfDNA-结果相比,单个GEP+/dd-cfDNA+结果使30天内GD或心血管死亡的发病率增加了三倍 (调整后IRR为3.12,p=0.007).

结论:

双重阳性GEP和dd-cfDNA结果确定心脏移植接受者在随后的移植功能障碍和心血管死亡的风险增加.
循环的多模式分子拒绝证据提供了独立于组织学并未被组织学检测的预后信息.
这些发现支持联合GEP和dd-cfDNA测试的实用性,以提高心脏移植监测中的风险分层.

关键词:

心血管疾病导致的死亡.捐赠者获得的无细胞DNA来自捐赠者.基因表达特征分析移植器官功能障碍移植器官功能障碍分子测试是分子测试.

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