Heart failure & cardiomyopathies
Heart allograft rejection: molecular diagnosis using intra-graft targeted gene expression profiling
Authors' conclusion
A novel FFPE-based molecular diagnostic system accurately identified cardiac allograft rejection.
Study context
- Population
- Heart transplant recipients with formalin-fixed, paraffin-embedded (FFPE) endomyocardial biopsies
- Participants
- 671 biopsies
- Comparison
- Molecular antibody-mediated rejection (AMR) and acute cellular rejection (ACR) classifiers vs pathologic grading
- Outcome
- Discrimination (ROC-AUC) and calibration of molecular classifiers for AMR and ACR
Methodological detailsinternational, internal and external validation, Gene expression by Banff Human Organ Transplant Panel, Main cohort 591 biopsies (AMR n = 188, ACR n = 289, matched non-rejection n = 114); derivation set n = 475, External validation cohort: AMR n = 20, ACR n = 32, non-rejection n = 28
- International
- Internal and external validation
- Gene expression by Banff Human Organ Transplant Panel
- Main cohort 591 biopsies (AMR n = 188, ACR n = 289, matched non-rejection n = 114); derivation set n = 475
- External validation cohort: AMR n = 20, ACR n = 32, non-rejection n = 28
Performance
As reported in the abstract
Identification of rejection (ROC-AUC)
| Test or model | AUC, internal validation | AUC, external validation |
|---|---|---|
| AMR model | 0.812 | 0.822 |
| ACR model | 0.849 | 0.815 |
AUC, internal validation
AMR model0.812
ACR model0.849
AUC, external validation
AMR model0.822
ACR model0.815
Further findings
Transcript profiles
- AMR: interferon-gamma pathway, endothelial activation, monocyte-macrophage recruitment transcripts
- ACR: T-cell receptor signalling, CD3 receptor activation, CD28 signalling transcripts
Original publication
Heart allograft rejection: molecular diagnosis using intra-graft targeted gene expression profiling. Eur Heart J. Published 4 December 2025. doi:10.
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