Graduation Date

Summer 8-13-2021

Document Type

Thesis

Degree Name

Master of Science (MS)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Brian Lowes, MD, PhD

Abstract

While heart transplantation remains the gold standard therapy for end-stage heart failure, complications remain common post-transplant. Infection is a common cause of morbidity and mortality within the first-year post-transplant. ImmuKnow (ViraCor-IBT Laboratories Inc.) is a cell mediated immunity (CMI) assay utilized in transplant populations to monitor the degree of immunosuppression. We aimed to determine whether utilization resulted in lower rates of infection and immunosuppression-related side effects. This was a prospective interventional trial of transplant patients from June 2018-June 2019. CMI was assessed at standard time points and adjustments in tacrolimus were made per set protocol. Outcomes were compared to historical controls. Thirty-one patients were enrolled in the intervention and control groups. There were no differences in average CMI levels between patients with infection versus those without infection. There were no significant differences in the number of patients with infections. Nine patients had bacterial infections within the 1st-year in the interventional group compared to 12 patients in the control group (p=0.6). Nine patients had a viral infection in the interventional group versus eight patients in the control group (p=0.7). There were no differences in rejection episodes between groups. There was no difference between groups in renal function or blood sugar control over one-year follow up. Use of CMI assay post-heart transplant did not result in lower incidence of infection nor in differences in renal function or blood sugar control. Further studies are needed to better evaluate the utility of routine use of this assay to guide immunosuppression following heart transplant.

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