Session Name: Biomarkers, Immune Assessment and Clinical Outcomes
Session Date & Time: None. Available on demand.
*Purpose: Immunosuppression titration post-orthotopic heart transplant (OHT) is limited to trough level monitoring and does not provide data pertaining to overall state of immunosuppression. Additional tests of immune cell function assay (ICFA; ImmuKnow®) and CD3 count may be useful in discerning intensity of immunosuppression to avoid adverse outcomes.
*Methods: Retrospective analysis identified OHT recipients 0-21 years of age transplanted at a large pediatric heart transplant center from 1/2018 to 12/2019. The co-primary outcome was difference in the median CD3 and ICFA within 30 days of either acute rejection or infection (defined as CMV/EBV DNAemia > 100 copies) within the first 6 months post-OHT. Patients received rabbit antithymocyte globulin (rATG) induction and maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and rapid steroid withdrawal.
*Results: A total of 57 patients were included comprising a combined 550 ICFA and CD3 values within the follow-up period. Age at transplant was 8.4 (IQR, 3-14.9) years, 59.7% were male, and median dosing of induction rATG used was 7.4 (IQR, 5.6-7.7) mg/kg total. There were 26 episodes of rejection and 17 episodes of infection, with the majority being in the first 2 months post-OHT. ICFA values preceding rejection were 282 (IQR, 152-419) ng/mL versus rejection-free periods of 174 (IQR, 71-356) ng/mL (p=0.014). CD3 counts preceding rejection were 169 (IQR, 32-418) cells/uL whereas rejection-free periods were 117.5 (IQR, 28-313) cells/uL (p=0.185). ICFA values were 184.5 (IQR, 46-280) ng/mL in those with infection and 191.5 (IQR, 88-366) ng/mL without infection (p=0.347). CD3 counts preceding infection were 186 (IQR, 73-321) cells/uL and 119 (28-327) cells/uL in those without infection (p=0.151) [Figure 1].
*Conclusions: ICFA values preceding episodes of rejection were higher than in rejection-free periods. This association needs further investigation in clinical trials. CD3 values were neither associated with infection or rejection within the first 6 months post-OHT.
To cite this abstract in AMA style:Chen J, Salerno D, Corbo H, Shah S, Rothkopf A, Lytrivi ID. Association of Immune Cell Markers with Adverse Outcomes in the First 6 Months Post-pediatric Heart Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/association-of-immune-cell-markers-with-adverse-outcomes-in-the-first-6-months-post-pediatric-heart-transplantation/. Accessed June 13, 2021.
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