Feingold And Team Published In Clinical Transplantation

Pitt Pediatrics congratulates Brian Feingold, MD, MS, FAHA, for his recent publication in Clinical Transplantation entitled, “Short-term Clinical Outcomes and Predicted Cost Savings of dd-cfDNA-led Surveillance after Pediatric Heart Transplantation.” Feingold is a Professor of Pediatrics and Clinical and Translational Science in the Division of Cardiology, as well as the Medical Director of Heart Failure and Transplant Programs at UPMC Children’s Hospital.

In this publication, Feingold and his research team compared the results of two surveillance protocols following pediatric heart transplantation (HT). The traditional protocol uses repeated surveillance endomyocardial biopsy (EMB), an inherently invasive test, to evaluate for rejection of the transplanted heart. Donor derived cell-free DNA (dd-cfDNA)-led surveillance offers an alternative to EMB, but detailed knowledge and research regarding its outcomes has been lacking. 

In comparing the two methods, Feingold and team looked at clinical outcomes prior to and following a switch from EMB to dd-cfDNA in pediatric and young adult HT recipients at UPMC Children’s Hospital. In addition, economic outcomes were evaluated and ultimately extrapolated outwards to make reasoned predictions regarding long-term comparisons of these two surveillance approaches. 

Results showed that over the course of nearly three years of clinical follow-up among 120 pediatric HT recipients that dd-cfDNA-led surveillance decreased the need for invasive EMBs at UPMC Children’s Hospital by almost 82%. There was no difference in clinical rejection events, need for re-transplantation, or death after the dd-cfDNA protocol was implemented. Additionally, dd-cfDNA-led surveillance is projected to cost between $8,500 and $24,500 less, per-patient, than EMB-led surveillance. 

This work is helping to shift the standard of care after pediatric heart transplantation, enabling cheaper and less invasive care for patients. 

In addition to Feingold, Kirsten Rose-Felker, MDShawn C. West, MD, MScSusan A. Miller, MD, MBA, and Matthew D. Zinn, DO, all of the Division of Cardiology, participated in the research, collection, and writing of this work.  

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