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Heart transplant Recipients’ perspectives on invasive versus Non-invasive graft failure surveillance Methods

      Highlights

      • 8 events reported at access site from EMB vs 3 events from AlloMap® testing.
      • Patients experienced less pain from an AlloMap® test than from an EMB.
      • There was no significant difference in the anxiety levels and adverse events.

      Abstract

      Background

      Heart transplant recipients must regularly be assessed for graft rejection; however, endomyocardial biopsy (EMB), can be stressful, painful, and inconvenient. AlloMap® is the only commercially available non-invasive test for graft rejection. Current guidelines include AlloMap® testing in low-risk patients

      Objectives

      To examine the patients’ perspective, this study compared patients’ experiences of AlloMap® and EMB surveillance at our center.

      Methods

      We enrolled consecutive heart transplant recipients who were to undergo routine EMB and AlloMap® testing (on different visits) to quantify their anxiety on the GAD-7 scale and their pain level on the Polyclinic Pain Scale. We assessed paired differences of anxiety and pain within patients according to surveillance method.

      Results

      We studied 43 participants (median age 60.5[54, 66] years; 35(81%) men; 27(63%) Caucasian). The median GAD-7 scores were 1[0, 4] and 2[0, 5] prior to EMB and AlloMap®, respectively (paired difference: 0[-1, 1],P = 0.323). The median pain scores were 1[0, 1] and 0[0, 0] for EMB and AlloMap®, respectively. Patients experienced less pain with AlloMap® testing compared to EMB (EMB–AlloMap;1[0, 1],P = 0.006). Seven (16%) participants experienced a total of 9 adverse events (pain, bruising, bleeding, swelling) from EMB vs 2(5%) participants who experienced a total of 3 adverse events (pain, bruising) from AlloMap®(P = 0.059).

      Conclusion

      Heart transplant recipients had less pain and fewer adverse events while undergoing graft rejection surveillance with AlloMap® testing compared to EMB. An additional benefit of AlloMap® testing is that it may be performed at home and reduce these high-risk patients’ infectious exposures.

      Key Words

      Abbreviation:

      EMB (Endomyocardial biopsy), GAD-7 (Generalized anxiety disorder-7), GEP (Gene expression profile)
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