Key result
Circulating biomarkers and molecular profiling optimize rejection surveillance to reduce invasive endomyocardial biopsies.
Why the study?
Endomyocardial biopsy for cardiac allograft rejection monitoring has limitations, creating a need for innovative diagnostic strategies integrating histology, molecular profiling, and non-invasive or tissue biomarkers.
Do non-invasive and tissue biomarkers improve the diagnosis and monitoring of cardiac allograft rejection compared to conventional endomyocardial biopsy in heart transplant recipients?
Do non-invasive and tissue biomarkers improve the diagnosis and monitoring of cardiac allograft rejection compared to conventional endomyocardial biopsy in heart transplant recipients?
The integration of novel non-invasive and tissue biomarkers with conventional histology may provide a more accurate, bio-histomolecular diagnosis of cardiac allograft rejection.
May support minimizing protocol biopsies in cardiac transplant recipients; leaves open prospective validation of integrated biomarker approaches.
Despite major advances in immunosuppression, allograft rejection remains an important complication after heart transplantation, and it is associated with increased morbidity and mortality. The gold standard invasive strategy to monitor and diagnose cardiac allograft rejection, based on the pathologic evaluation of endomyocardial biopsies, suffers from many limitations including the low prevalence of rejection, sample bias, high inter-observer variability, and international working formulations based on arbitrary cut-offs that simplify the landscape of rejection. The development of innovative diagnostic and prognostic strategies-integrating conventional histology, molecular profiling of allograft biopsy, and the discovery of new tissue or circulating biomarkers-is one of the major challenges of translational medicine in solid organ transplantation, and particularly in heart transplantation. Major advances in the field of biomarkers of rejection have paved the way for a paradigm shift in the monitoring and diagnosis of cardiac allograft rejection. We review the recent developments in the field, including non-invasive biomarkers to minimize the number of protocol endomyocardial biopsies and tissue biomarkers as companion tools of pathology to refine the diagnosis of cardiac rejection. Finally, we discuss the potential role of these biomarkers to provide an integrated bio-histomolecular diagnosis of cardiac allograft rejection.
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Coutance et al. (2022) conducted a review in Cardiac allograft rejection. Non-invasive and tissue biomarkers (e.g., dd-cfDNA, AlloMap, molecular profiling) vs. Protocol endomyocardial biopsy (EMB) was evaluated. The integration of non-invasive circulating biomarkers and tissue molecular profiling offers a promising paradigm shift to minimize protocol biopsies and refine the diagnosis of cardiac allograft rejection.
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