Gabriel Sayer

Donor-derived cell-free DNA (dd-cfDNA) is a reliable, noninvasive marker for detecting allograft rejection after heart transplantation (HT). We evaluated whether dd-cfDNA levels differ in recipients of ABO-compatible, nonidentical (mismatched) grafts. We performed a retrospective single-center cohort study of 219 adult HT recipients transplanted between January 2019 and May 2023, each with at least one dd-cfDNA sample collected between November 2019 and April 2024. ABO mismatch was defined as a donor blood type A, B, or AB that was compatible with but nonidentical to the recipient’s type; only ABO-compatible transplants were included. dd-cfDNA was measured using a commercially available assay (AlloSure, CareDx, Brisbane, CA), and a level ≥0.20% was defined as positive. A total of 1,783 dd-cfDNA tests were analyzed, with a 16.0% overall positivity rate. Positivity was 20.1% in the mismatched group and 15.5% in the matched group, with no statistically significant difference whether dd-cfDNA was treated as a binary ( p = 0.95) or continuous ( p = 0.26) variable. No statistically significant differences were observed between groups in gene expression profiling, donor-specific antibodies, rejection, or survival. In this adult cohort, ABO-compatible nonidentical HT was not associated with higher dd-cfDNA levels, although the small mismatched subgroup limits statistical power.

Pericarditis is the most common cardiac manifestation of systemic lupus erythematosus (SLE), yet optimal management remains poorly defined. Glucocorticoids are frequently used but are associated with toxicity and increased recurrence risk. Interleukin-1 (IL-1) inhibition has demonstrated efficacy in recurrent pericarditis, though data in SLE-associated pericarditis is limited. In order to evaluate the clinical impact of IL-1 blockade on the treatment of SLE-associated recurrent pericarditis, we performed a retrospective case series of six patients with SLE-associated recurrent pericarditis treated with the IL-1 inhibitor rilonacept at a tertiary care cardio-rheumatology center. Clinical response, inflammatory markers, imaging findings, and use of concomitant therapies were assessed before and after IL-1 inhibition. Following initiation of rilonacept, all six patients achieved clinical improvement: three (50%) attained complete symptom resolution and three (50%) demonstrated partial symptomatic improvement. C-reactive protein normalized in all four patients with elevated baseline levels. Any post-treatment imaging, available in five of six patients (83.3%), demonstrated objective reduction in pericardial inflammation or effusion in all five. Use of concomitant therapies decreased substantially. IL-1 blockade with rilonacept was associated with clinical and imaging improvement and substantially reduced reliance on glucocorticoids and other anti-inflammatory agents in SLE-associated recurrent pericarditis. These findings support IL-1 inhibition as a targeted, steroid-sparing strategy in refractory disease and further prospective investigation.

1. The global burden of heart failure continues to escalate, and its management remains a critical challenge in contemporary medicine [1]. While pharmacological therapies have advanced substantiall...