Allomap Protocol

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Allomap Protocol
Inclusion/ Exclusion criteria for patients with stable heart
function who are ≥ 2 years post heart transplant
**If YES is checked on any of the criteria, the patient is NOT eligible for Allomap
testing at this time**
(Please check all boxes that apply)
Yes
No
1. Signs/symptoms of cardiac allograft dysfunction
2. LV EF < 40%
3. Cardiac Index < 2 L/min
4. Recurrent grade 3A/2R cellular rejection
5. History of a grade ≥ 3A/2R cellular rejection within the preceding 6 months
6. History of antibody mediated rejection with the preceding 12 months
7. High-dose steroids IV or oral ≥ 20mg prednisone equivalent in the past 30 days?
8. Had a change in an immunosuppressive (IS) AGENT in the last 12 months?
9. Had a decrease in current IS regimen of 30% or greater in the last 12 months?
10. Has the patient had a blood transfusion with the last 30 days?
11. Has the patient had Neupogen (filgrastim) in the last 30 days?
12. Has the patient had Leukine (sargramostim) in the last 30 days?
13. Is the patient pregnant?
14. Is the patient < 15 years of age?
Starling RC, Pham M, Valantine H, et al. Molecular testing in the management of cardiac transplant
recipients: initial clinical experience. J Heart Lung Transplant 2006; 25:1389-95.
Revised 6/07
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