(558) Impact of Rejection Surveillance Practices on Outcomes after Heart Transplantation

PurposeThe prevalence of using endomyocardial biopsy (EMB) or gene expression profiling and donor derived cell-free DNA, i.e. HeartCare (HC), varies greatly among programs in the US. This study aims to determine if frequency surveillance after HT correlates with clinical outcomes.MethodsPatients from multi-center Surveillance Outcomes Registry (SHORE) at least 1 year follow-up were included. Multi-organ transplant “for cause” HC EMBs excluded. classified by tertiles average number within post HT: low <3, medium 3-5, high >5; (HC) was as <5, 5-8, > 8. Clinical outcomes included rejection (ACR ≥2R, AMR ≥1), graft dysfunction (LVEF < 30% drop >25%), de novo specific antibodies (dnDSA), ISHLT cardiac allograft vasculopathy Grade 2/3 (CAV) HT. Mortality assessed account for lower testing rates those who did not survive their first year.Results1882 patients met inclusion criteria (74% Male, 67% White, mean age 54 ±13 years). 7547 11,239 tests performed during (mean 4 (±3) EMB/patient 7 HC/patient). The incidence 11.5%, including ACR ≥2R (5.8%) ≥1 (5.2%). Overall mortality 2.9% (n=55). A higher (mostly ACR) noted EMB group compared (20.8% vs 3.7%, p<0.001); well vs. cohort (13.5% 9.2%, p=0.04) survival similar across groups (Figure 1A 1B).ConclusionThis analysis highlights varied practices US hospitals. Higher levels associated more frequent when HT, which may be a reflection risk patient population. Further work is necessary elucidate preferred method surveillance. outcomes. Patients year. 1882 1B).