Heart failure & cardiomyopathies
Identification of Heart Transplant Rejection Subtypes With Circulating MicroRNAs
- prospective, longitudinal cohort study
- 5-center
+1 more
- 5-center
Authors' conclusion
Circulating microRNAs reliably identified ACR and AMR on EMB. An elevated microRNA CRS was associated with an increased risk of subsequent rejection, allograft dysfunction, or death. This biomarker, with further validation, can serve as a noninvasive test to screen and diagnose ACR and AMR without the need for an EMB.
Study context
- Population
- Heart transplant recipients with blood samples obtained at the time of an endomyocardial biopsy (EMB)heart transplant recipients, 922 blood samples sequenced, 720 paired with EMB
- Participants
- 173 recipients
- Exposure
- Microrna clinical rejection scores (CRS) against rejection on endomyocardial biopsy (EMB)
- Acute cellular rejection (ACR)n = 14
- Antibody-mediated rejection (AMR)n = 25
Main finding
As reported in the abstract
Median ACR CRS, ACR vs without ACR
ACR
78
14 of 14
without ACR
42
median ACR CRS
Observational data: associations, not effects.
Further findings
| Outcome | hazard ratio (95% CI) | P value | |
|---|---|---|---|
| Composite of subsequent ACR or AMR by EMB, allograft dysfunction, or death, per 10-point increase in CRS — 10-point increase in ACR CRS · adjusted · After adjustment | 1.42 (1.20–1.69) | P < 0.001 | |
| Composite of subsequent ACR or AMR by EMB, allograft dysfunction, or death, per 10-point increase in CRS — 10-point increase in AMR CRS · adjusted · After adjustment | 1.45 (1.14–1.86) | P = 0.003 | |
| 0.512Hazard ratio (log scale) |
| Outcome | ACR | AMR | Estimate | P value | |
|---|---|---|---|---|---|
| Median AMR CRS, AMR vs without AMR | Not reported in the abstract | median AMR CRS 75 | ACR: not reported in the abstract |
- Median AMR CRS, AMR vs without AMR: without AMR median AMR CRS 53
- Median AMR CRS, AMR vs without AMR: P <0.001
- Diagnostic performance of CRS: ACR CRS AUC 0.93 · sensitivity (threshold 65) 79% · specificity (threshold 65) 97% · negative predictive value (threshold 65) 100%
- Diagnostic performance of CRS: AMR CRS AUC 0.92 · sensitivity (threshold 65) 84% · specificity (threshold 65) 86% · negative predictive value (threshold 65) 99%
Tests with both ACR and AMR CRS <65
- ACR and AMR CRS both <65
- 589 (82%) of the tests
Original publication
Identification of Heart Transplant Rejection Subtypes With Circulating MicroRNAs. Circ Heart Fail. Published 12 January 2026. doi:10.1161/circheartfailure.124.013141
Summarised from the published abstract; every number is checked against it