Title : Role of non-invasive diagnostic modalities in detection of allograft rejection post cardiac transplantation
Abstract:
Heart transplantation continues to be the definitive treatment for end-stage heart failure. With the median survival of 15 years among first-year survivors, allograft rejection (AR) and allograft injury after cardiac transplantation still remains a challenging obstacle to post surgery long-term survival. So far, the invasive diagnostics in form of endomyocardial biopsy (EMB) remains the gold standard surveillance tool for rejection following heart transplant.
Conventional tests such as electrocardiography, echocardiography, and serum biomarkers have low sensitivity and specificity to detect AR and are not recommended as potential alternatives to EMB. But donor derived cell free DNA (cfDNA), known as liquid biopsy, is rapidly becoming a highly useful tool for surveillance of solid organ transplant rejection. It is more sensitive in picking antibody-mediated rejection than ACR. cfDNA/RNA studies can potentially replace EMB in future. CMR-based surveillance strategy in addition to routine echocardiography for ACAR in the first year after orthotopic heart transplantation is also feasible compared with EMB-based surveillance. Gene expression profiling of the genes involved in cellular rejection has a high negative predictive value of 99.6% for moderate to severe cellular rejection but poor positive predictive value and unclear relevance to antibody-mediated rejection.
Some of the novel approaches successfully tested in preclinical and clinical models while some in the developmental phases, may lead to a prolongation of patient’s and heart allograft survival and a step closer to a new diagnostic standard for AR.
Audience Take Away Notes
Current updates and developments in the field of cardiac rejection monitoring
Incorporation of newer diagnostic modalities in their setup for diagnosis of heart transplant rejection algorithms
Updating of allograft rejection algorithms
Earlier detection of rejection and better outcomes post cardiac transplantation
