Clinical Scorecard: Altered Cardiac MRI Mapping Metrics in Pediatric Heart Transplant Recipients with Increased Levels of Donor-Derived Cell-Free DNA

At a Glance

Key Highlights

• High ddcfDNA levels correlate with increased history of cardiac allograft vasculopathy (CAV) and moderate/severe rejection.
• CMR is performed biennially as an alternative to invasive endomyocardial biopsy (EMB) in select patients.
• DdcfDNA testing is routinely conducted every 3-4 months to enhance rejection surveillance.

Guideline-Based Recommendations

Diagnosis

• Rejection defined by ISHLT scoring of ≥ 2R Acute Cellular Rejection (ACR) or any antibody mediated rejection (AMR).

Management

• Consider CMR as a non-invasive alternative for rejection surveillance in pediatric heart transplant recipients.

Monitoring & Follow-up

• Routine ddcfDNA testing at every clinic visit to monitor for rejection.

Risks

• Increased risk of rejection associated with elevated ddcfDNA levels.

Patient & Prescribing Data

Pediatric heart transplant patients with varying levels of ddcfDNA.

High ddcfDNA levels indicate a need for closer monitoring and potential intervention.

Clinical Best Practices

• Utilize CMR for comprehensive myocardial assessment in pediatric heart transplant recipients.
• Incorporate ddcfDNA testing into routine surveillance protocols.

Related Resources & Content

• ISHLT Guidelines
• AlloSure Testing
• Society for Cardiovascular Magnetic Resonance Guidelines