{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T06:30:04Z","timestamp":1777703404227,"version":"3.51.4"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>In heart transplantation, antibody-mediated rejection (AMR) is a major contributor to patient morbidity and mortality. Multiple routine endomyocardial biopsies (EMB) remain the gold standard to detect AMR, but this invasive procedure suffers from many limitations. We aimed to develop and validate an AMR risk model to improve individual risk stratification of AMR.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Heart recipients from 2 referral transplant centers, Cedars-Sinai (US) and Piti\u00e9-Salp\u00eatri\u00e8re (France), were included from 2012 to 2019. Database included detailed clinical, immunologic, imaging, and histological parameters. The US cohort was randomly distributed in a derivation (2\/3) and in a test set (1\/3). The primary end point was biopsy-proven AMR. A mixed effect logistic regression model with a random intercept was applied to identify variables independently associated with AMR. Simulation analyzes were performed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              The US and French cohorts comprised a total of 1341 patients, representing 12\u2009864 EMB. Overall, 490 AMR episodes were diagnosed (3.8% of EMB). Among the 26 potential determinants of AMR, 5 variables showed independent association: time post-transplant (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), pretransplant sensitizing event (\n              <jats:italic>P<\/jats:italic>\n              =0.001), circulating donor-specific anti\u2013human leukocyte antigen antibody (\n              <jats:italic>P<\/jats:italic>\n              =0.001), graft dysfunction (\n              <jats:italic>P<\/jats:italic>\n              =0.004), and prior history of definite AMR (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). In the US test set, the calibration and the discrimination of the model were accurate (area under the curve, 0.79 [95% CI, 0.78\u20130.81]). Those results were confirmed in the external validation cohort (area under the curve, 0.78 [95% CI, 0.77\u20130.79]) and reinforced by various sensitivity analyses. The model also showed good performance to predict overall cause of rejection. Simulation models revealed that the AMR risk model could safely reduce the number of EMB.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Our results support the use of the AMR risk model as a clinical decision tool to minimize the number of routine EMB after heart transplantation.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.122.009923","type":"journal-article","created":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T09:00:10Z","timestamp":1665046810000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Clinical Prediction Model for Antibody-Mediated Rejection: A Strategy to Minimize Surveillance Endomyocardial Biopsies After Heart Transplantation"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4939-2175","authenticated-orcid":true,"given":"Guillaume","family":"Coutance","sequence":"first","affiliation":[{"name":"University of Paris, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.)."},{"name":"Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitie\u0301 Salpe\u0302trie\u0300re Hospital, Assistance Publique-H\u00f4pitaux de Paris (AP-HP), Sorbonne University Medical School, Paris, France (G.C., P.L., S.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0507-2412","authenticated-orcid":true,"given":"Evan","family":"Kransdorf","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.K., J.K., P.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier","family":"Aubert","sequence":"additional","affiliation":[{"name":"University of Paris, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.)."},{"name":"Kidney Transplant Department, H\u00f4pital Necker, AP-HP, Paris, France (O.A., A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3027-1771","authenticated-orcid":true,"given":"Guillaume","family":"Bonnet","sequence":"additional","affiliation":[{"name":"University of Paris, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Yoo","sequence":"additional","affiliation":[{"name":"University of Paris, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2198-251X","authenticated-orcid":true,"given":"Philippe","family":"Rouvier","sequence":"additional","affiliation":[{"name":"Pathology Department, La Piti\u00e9 Salp\u00e9tri\u00e8re, AP-HP, Paris, France (P.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Paul","family":"Duong Van Huyen","sequence":"additional","affiliation":[{"name":"Pathology Department, H\u00f4pital Necker, AP-HP and Universit\u00e9 de Paris, Paris, France (J.-P.D.V.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Bruneval","sequence":"additional","affiliation":[{"name":"University of Paris, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.)."},{"name":"Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.K., J.K., P.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Luc","family":"Taupin","sequence":"additional","affiliation":[{"name":"Laboratory of Immunology and Histocompatibility, H\u00f4pital Saint-Louis, AP-HP, Paris, France (J.-L.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascal","family":"Leprince","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitie\u0301 Salpe\u0302trie\u0300re Hospital, Assistance Publique-H\u00f4pitaux de Paris (AP-HP), Sorbonne University Medical School, Paris, France (G.C., P.L., S.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaida","family":"Varnous","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitie\u0301 Salpe\u0302trie\u0300re Hospital, Assistance Publique-H\u00f4pitaux de Paris (AP-HP), Sorbonne University Medical School, Paris, France (G.C., P.L., S.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Kobashigawa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.K., J.K., P.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier","family":"Jouven","sequence":"additional","affiliation":[{"name":"University of Paris, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.)."},{"name":"Cardiology and Heart Transplant Department, H\u00f4pital Pompidou, AP-HP, Paris, France (X.J.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0618-6750","authenticated-orcid":true,"given":"Jignesh","family":"Patel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3388-7747","authenticated-orcid":true,"given":"Alexandre","family":"Loupy","sequence":"additional","affiliation":[{"name":"University of Paris, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, UMR 970, Paris Translational Research Centre for Organ Transplantation, Paris, France (G.C., O.A., G.B., D.Y., P.B., X.J., A.L.)."},{"name":"Kidney Transplant Department, H\u00f4pital Necker, AP-HP, Paris, France (O.A., 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