OPtimal Adult Heart Transplant Immunosuppression With MicroRNA Levels
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- This is an observational study: the protocol does not assign a study treatment.
- Who it may be relevant to
- Registry conditions: Cardiac Failure, Graft Rejection. Basic parameters: 18 years — 99 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- United States
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
This study aims to develop and refine a microRNA (miR) biomarker panel that can be used to phenotype net immune state after heart transplantation using circulating miRs (associated with drug doses and levels). These miRs will be used to characterize the overall immune state in adult heart transplant patients and predict patients that will go on to develop infection and rejection. MicroRNAs (miRs) are small, non-coding RNA molecules that regulate gene expression and serve as molecular biomarkers found in the circulation.
Detailed description
The study objectives will be accomplished in a prospective, multicenter observational, longitudinal cohort study that includes \~250 Heart Transplant patients from the United States. Patients will be screened for eligibility and enrolled \~1 month (± 2 weeks) after transplant. Study participation will last 36 months.
All patients will follow the center's standard of care surveillance schedule after transplant. Blood samples will be collected for miR evaluation at:
1. specified time intervals after transplant and 2. when a clinical event of interest occurs, including treated rejection, or infection.
Research samples will be collected and used to evaluate miR expression as well as other biomarkers related to heart transplantation and immunosuppression medications. Additional data collection will include demographics, medical history, medications, human leukocyte (HLA)/donor specific antibody (DSA) evaluations, endomyocardial biopsy (EMB) echocardiography, donor-derived cell-free DNA (dd-cfDNA), and other post-transplant events and testing.
This work will form the basis for a non-invasive, genomic blood test that can be used to monitor patients after heart transplant to mitigate complications of over-immunosuppression, such as infection, without increasing the risks of under-immunosuppression, such as rejection.
Primary outcome measures
- Time-to-Event Analysis of Circulating microRNAs (miRs) Predicting Infection in Pediatric Heart Transplant Recipients [Time frame: up to 3 years post - transplant]
- Time-to-Event Analysis of Circulating microRNAs (miRs) Predicting Rejection in Pediatric Heart Transplant Recipients [Time frame: up to 3 years post - transplant]
Eligibility criteria
Inclusion criteria
- Age ≥ 18 years at enrollment
- Receipt of orthotopic heart transplant (OHT) within the prior 1 month ± 2 weeks
- Planned follow-up at the transplant center for a minimum of one-year.
- Patient able and willing to comply with the study visit schedule, study procedures, and study requirements.
Exclusion criteria
- Recipient of a multi-organ transplant
- History of prior solid organ transplant before the index heart transplant
- Ongoing mechanical circulatory support or hemodynamic instability (e.g., inotrope or vasopressor therapy)
- Ongoing need for renal replacement therapy and/or dialysis
- Active infection requiring either a) hospitalization b) treatment with antimicrobial therapy or c) reduction in immunosuppression
- Active rejection being treated with intravenous medications or plasmapheresis
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Cohort
Study locations
United States · 7 centers
- Cedars-Sinai Medical Center — Los Angeles
- Stanford University — Palo Alto
- Tufts Medical Center — Boston
- Medical University of South Carolina — Charleston
- Vanderbilt University — Nashville
- Baylor University Medical Center — Dallas
- Inova Health System — Falls Church
Publications
- Shah P, Bristow MR, Port JD. MicroRNAs in Heart Failure, Cardiac Transplantation, and Myocardial Recovery: Biomarkers with Therapeutic Potential. Curr Heart Fail Rep. 2017 Dec;14(6):454-464. doi: 10.1007/s11897-017-0362-8. PMID 28940102
- Shah P, Agbor-Enoh S, Bagchi P, deFilippi CR, Mercado A, Diao G, Morales DJ, Shah KB, Najjar SS, Feller E, Hsu S, Rodrigo ME, Lewsey SC, Jang MK, Marboe C, Berry GJ, Khush KK, Valantine HA; GRAfT Investigators. Circulating microRNAs in cellular and antibody-mediated heart transplant rejection. J Heart Lung Transplant. 2022 Oct;41(10):1401-1413. doi: 10.1016/j.healun.2022.06.019. Epub 2022 Jun 28. PMID 35872109
Identifiers
NCT: NCT06939751 · INOVA-2024-372 · 1R01HL173248-01A1