Perspectives of Heart Transplant Patients and Providers on Acute Rejection Surveillance: A Mixed‐Methods Study
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| Formato: | Artículo Open Access |
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Wiley
2026
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| _version_ | 1867008399618605056 |
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| author | Hyoungmin Kim Vincenzo Cusi Melissa McLenon Jose Benjamin Cruz Rodriguez Quan M. Bui Jennifer Chak Marcus Anthony Urey Justin Cole Rebecca Fielding‐Miller Paul J. Kim |
| author_facet | Hyoungmin Kim Vincenzo Cusi Melissa McLenon Jose Benjamin Cruz Rodriguez Quan M. Bui Jennifer Chak Marcus Anthony Urey Justin Cole Rebecca Fielding‐Miller Paul J. Kim Hyoungmin Kim Vincenzo Cusi Melissa McLenon Jose Benjamin Cruz Rodriguez Quan M. Bui Jennifer Chak Marcus Anthony Urey Justin Cole Rebecca Fielding‐Miller Paul J. Kim |
| collection | Wiley Open Access |
| contents | Perspectives of Heart Transplant Patients and Providers on Acute Rejection Surveillance: A Mixed‐Methods Study Hyoungmin Kim Vincenzo Cusi Melissa McLenon Jose Benjamin Cruz Rodriguez Quan M. Bui Jennifer Chak Marcus Anthony Urey Justin Cole Rebecca Fielding‐Miller Paul J. Kim Clinical Transplantation ABSTRACT Background Endomyocardial biopsies (EMB) remain the reference standard for detection of acute rejection in heart transplant (HTx) patients. Recent studies evaluating novel noninvasive tests have sparked a renewed discussion in the HTx community about revising acute rejection surveillance policies. However, patient and provider perspectives remain underexplored. This single‐center study examined both HTx patient and provider perspectives on replacing EMBs earlier with noninvasive blood tests. Methods We performed semi‐structured interviews with 28 HTx patients to explore their perspectives on replacement of EMBs with donor‐derived cell‐free DNA (dd‐cfDNA) early post‐HTx. We subsequently conducted a survey of 118 HTx patients using self‐administered online questionnaires. We also performed semi‐structured interviews with 18 HTx providers to explore their perspectives. Thematic analysis was performed on interview and open‐ended survey responses using deductive and inductive approaches. Patient quantitative survey responses were analyzed with descriptive statistics. Results Our study identified three key themes: patient anxiety related to EMBs, importance of patient‐provider communication, and strong interpersonal trust in providers by HTx patients. Although 78.4% of patients experienced EMB‐related anxiety, they prioritized testing accuracy to ensure “the health of their new heart.” Consequently, patients favored the most accurate testing protocol and trusted providers to make this decision (91.1%). HTx providers raised concerns about the accuracy and safety of noninvasive surveillance testing for high‐risk patients. Conclusion HTx patients trusted their providers to determine the most accurate acute rejection surveillance policy. Additionally, our study provides important patient‐centered priorities to guide the implementation of early noninvasive testing into clinical practice. Trial Registration : ClinicalTrials.gov identifier: NCT06414603 10.1111/ctr.70438 http://creativecommons.org/licenses/by-nc/4.0/ |
| doi_str_mv | 10.1111/ctr.70438 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70438 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc/4.0/ |
| publishDate | 2026 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Perspectives of Heart Transplant Patients and Providers on Acute Rejection Surveillance: A Mixed‐Methods Study Hyoungmin Kim Vincenzo Cusi Melissa McLenon Jose Benjamin Cruz Rodriguez Quan M. Bui Jennifer Chak Marcus Anthony Urey Justin Cole Rebecca Fielding‐Miller Paul J. Kim Clinical Transplantation Perspectives of Heart Transplant Patients and Providers on Acute Rejection Surveillance: A Mixed‐Methods Study Hyoungmin Kim Vincenzo Cusi Melissa McLenon Jose Benjamin Cruz Rodriguez Quan M. Bui Jennifer Chak Marcus Anthony Urey Justin Cole Rebecca Fielding‐Miller Paul J. Kim Clinical Transplantation ABSTRACT Background Endomyocardial biopsies (EMB) remain the reference standard for detection of acute rejection in heart transplant (HTx) patients. Recent studies evaluating novel noninvasive tests have sparked a renewed discussion in the HTx community about revising acute rejection surveillance policies. However, patient and provider perspectives remain underexplored. This single‐center study examined both HTx patient and provider perspectives on replacing EMBs earlier with noninvasive blood tests. Methods We performed semi‐structured interviews with 28 HTx patients to explore their perspectives on replacement of EMBs with donor‐derived cell‐free DNA (dd‐cfDNA) early post‐HTx. We subsequently conducted a survey of 118 HTx patients using self‐administered online questionnaires. We also performed semi‐structured interviews with 18 HTx providers to explore their perspectives. Thematic analysis was performed on interview and open‐ended survey responses using deductive and inductive approaches. Patient quantitative survey responses were analyzed with descriptive statistics. Results Our study identified three key themes: patient anxiety related to EMBs, importance of patient‐provider communication, and strong interpersonal trust in providers by HTx patients. Although 78.4% of patients experienced EMB‐related anxiety, they prioritized testing accuracy to ensure “the health of their new heart.” Consequently, patients favored the most accurate testing protocol and trusted providers to make this decision (91.1%). HTx providers raised concerns about the accuracy and safety of noninvasive surveillance testing for high‐risk patients. Conclusion HTx patients trusted their providers to determine the most accurate acute rejection surveillance policy. Additionally, our study provides important patient‐centered priorities to guide the implementation of early noninvasive testing into clinical practice. Trial Registration : ClinicalTrials.gov identifier: NCT06414603 10.1111/ctr.70438 http://creativecommons.org/licenses/by-nc/4.0/ |
| title | Perspectives of Heart Transplant Patients and Providers on Acute Rejection Surveillance: A Mixed‐Methods Study |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70438 |