Transplant Trial Watch

Cost-Effectiveness of Cardiovascular Magnetic Resonance for Rejection Surveillance After Cardiac Transplantation in the Australian Health Care System.

Pouliopoulos, J., et al.

Heart, Lung & Circulation 2024 [record in progress].

To assess the cost-effectiveness of MRI surveillance for acute rejection following cardiac transplant.

Patients were randomised to receive standard of care, endomyocardial biopsies (EMB) or cardiac MRI (CMR) for rejection surveillance in the first year following transplant.

40 adult orthotopic heart transplant recipients.

Primary outcomes were total cost and QALYs for this secondary analysis. Secondary outcomes were number of rejection events, hospitalisations, LOS and unplanned events.


CET Conclusions
This is a post-hoc analysis of Athony et al’s original trial (Circulation, 2022) focusing on the cost-effectiveness of CMR over EMB for surveillance of rejection in the first year following cardiac transplant. They demonstrate that substituting EMB with CMR saves costs significantly, by employing CMR and selective EMB they found a total cost reduction of 65%, which could yield a saving of AUD$1.3-2.3 million. The use of selective biopsy significantly reduces the number performed in the CMR of the trial with them only accounting for 6.3% of surveillance events. While this post-hoc analysis was not assessing rejection per se, though was considering some of the cost implications od rejection events, it is worth noting that capture rates for rejection and timely alterations to immunosuppressive regimes were unaffected, and in fact due to the reduced number of biopsies, when they were required they were more likely to be diagnostic given the reduced number resulting in less capture of biopsy-site reaction, fibrosis or myocyte replacement from previous biopsies. The original trial however did not have a comprehensive analysis of the longer-term effects. They present a single centre study, and the early phase of more detailed analysis and multi-centre assessment of this surveillance approach. They have in their original trial presented a potentially paradigm shifting method of post-op surveillance which could demonstrate increased cost effectiveness as well as patient improved QALYs, without effects on capture and management of rejection events.

Trial registration

Funding source
Non-industry funded