Purpose for ALLOMAP testing
ALLOMAP molecular expression testing is a blood test that measures specific gene expression patterns to help define and identify immune activity in the early rejection process in cardiac allograft recipients. ALLOMAP can also reduce the number of invasive biopsies in selected patients who meet the indications for ALLOMAP testing as identified below.
Plan/Management

Educate patient about the purpose of Allomap testing

Explain scoring result and what it means

Follow Allomap protocol based on score for further testing or treatment needs
Indications for Use of ALLOMAP
1.
Patient is clinically stable a.
Pt does not show signs/symptoms of cardiac allograft dysfunction b.
LV EF > 40% c.
Cardiac Index > 2L/min d.
No history of grade 3A/2R rejection with in preceding 6 months e.
No history of antibody mediated rejection with in preceding 6 months
2.
Patient must be 15 years or older
3.
Patient cannot be pregnant
4.
Patient must be > 24 months from time of transplant
Special Considerations
1.
Prednisone or equivalent dosage > 20mg in the past 30 days
2.
> 21 days post graft dysfunction
3.
Significant change in immunosupression (> 25% increase or reduction of standard dose)
4.
Patient has had change in immunosuppressive agent in last 12 months
5.
Patient has had blood transfusion in last 30 days
6.
Patient is/has taken Neupogen/ Leukine/ Procrit in past 30 days
Physician Consult
Always consult transplant physician regarding result and further treatment plan
ALLOMAP Threshold Scores
12 months to 24 months 30
24 months- beyond 34

BIOPSY and ALLOMAP Testing For Cardiac Allograft Recipient
Biopsy Schedule for First Year of Transplant
Every week x 4 after initial biopsy in hospital –then-
Every other week x 2 –then-
Every month x 2 –then-
Every 6 weeks until the end of year one
At 12 months:
Annual studies to include ECHO, LHC/RHC/RV bx and then biopsies Q3 months
At 24 months:
ALLOMAP or biopsy if indicated Q 6 months
At 36 months:
ALLOMAP or biopsy if indicated yearly with annual studies testing
References
Yamani MH, Taylor DO, Haire C, Smedira N, Starling RC. Post-transplant ischemic injury is associated with up-regulated AlloMap gene expression.
Clinical Transplant.
2007 Jul-Aug; 21(4):523-5.
Yamani MH, Taylor DO, Rodreguiez ER, Cook DJ, Zhou L, Smedira N, Starling RC.
Transplant Vasculopathy is associated with increased AlloMap gene expression score.
Journal of Heart Lung Transplant . 2007 April;26(4):403-6.