Almost 1 in 3 heart failure patients have circulating antibodies against foreign tissue, making it difficult to find compatible donors and elevating the risk of rejection for heart transplant candidates. Our carefully developed desensitization protocol, coupled with numerous trials investigating novel pharmaceutical options, allows patients with even 100% circulating antibody presence to undergo a heart transplant with minimal risk of acute and chronic rejection.
This dramatic increased opportunity for transplant therapy is extended further by our deep experience in mechanical circulatory support and the recently FDA-approved heart-in-a-box for donor organ care, which has transformed our regional pool of donor hearts into a national one.
These strides in pre- and post-transplant care have supported excellent five-year patient survival. We use prognostic biomarkers to diagnose true rejection and inform treatment decisions, helping us reduce invasive heart biopsies by 67% and improve diagnostic accuracy and care for patients at the greatest risk for poor outcomes.
BRINGING MOLECULAR BIOLOGY TO TRANSPLANTATION
The Smidt Heart Institute is one of only four centers in the world included in an initiative funded by the National Institutes of Health (NIH) to reveal the RNA transcripts and activated immune pathways at play in heart transplant patients using standard biopsies. This molecular and spatial biology endeavor aims to utilize NanoString technology to reveal which patients are at risk for antibody-mediated rejection or cellular reactivity, even decades in advance.
The main clinical goal: adjust medication regimens to customize immuno-suppression in the peri-transplant period. Although the program has just begun, myriad existing biobank samples and AI applications hold tremendous potential to accelerate this approach to a cellular and immune-based understanding of heart health and, in doing so, to achieve the goal of true precision medicine.
The OCS Heart, or “Heart in a Box,” enables transplant surgeons to travel farther to procure lifesaving organs by acting as a miniature intensive care unit that keeps the heart alive.
RELEVANT RECENT PUBLICATIONS
Contemporary Left Ventricular Assist Device Outcomes in an Aging Population: An STS INTERMACS Analysis, Journal of the American College of Cardiology; PMID 34446160
Solid Gold, or Liquid Gold?: Towards a New Diagnostic Standard for Heart Transplant Rejection, Circulation; PMID: 33750203
Sensitization in Heart Transplantation: Emerging Knowledge: A Scientific Statement From the American Heart Association, Circulation; PMID: 30776902