Key result
Noninvasive molecular diagnostics, including gene expression profiling and donor-derived cell-free DNA, offer high negative predictive value and up to 81% sensitivity and 85% specificity for detecting heart transplant rejection, reducing reliance on endomyocardial biopsy.
Why the study?
Although endomyocardial biopsy is the gold standard for post-transplant rejection monitoring, its invasiveness and limitations have driven innovations in noninvasive surveillance techniques.
Does noninvasive surveillance with GEP and dd-cfDNA accurately detect rejection compared to endomyocardial biopsy in heart transplant recipients?
Does noninvasive surveillance with GEP and dd-cfDNA accurately detect rejection compared to endomyocardial biopsy in heart transplant recipients?
Integrating gene expression profiling and donor-derived cell-free DNA offers a multimodal, noninvasive approach to rejection surveillance in heart transplant recipients, reducing the need for routine endomyocardial biopsies.
Noninvasive molecular surveillance may reduce biopsy burden post-transplant; leaves open integration into routine protocols.
Post-transplant rejection surveillance remains a cornerstone of heart transplant care. Although endomyocardial biopsy has long been the gold standard for monitoring rejection, its invasiveness and limitations have driven innovations in noninvasive techniques. Molecular diagnostics, including gene expression profiling (GEP) and donor-derived cell-free DNA (dd-cfDNA), have emerged as promising alternatives with demonstrated utility. GEP excels in identifying immune activation with high negative predictive value, while dd-cfDNA provides insights into allograft injury, with sensitivity up to 81% and specificity of 85%. Complementary cardiac imaging such as echocardiography and cardiac magnetic resonance enhance graft assessment by providing structural and functional data. Together, these investigations offer a multimodal approach to rejection surveillance, reducing the frequency of endomyocardial biopsy and improving overall care for transplant recipients.
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Alansari et al. (2025) conducted a review in Heart transplant rejection. Gene expression profiling and donor-derived cell-free DNA vs. Endomyocardial biopsy was evaluated. Noninvasive molecular diagnostics, including gene expression profiling and donor-derived cell-free DNA, offer high negative predictive value and up to 81% sensitivity and 85% specificity for detecting heart transplant rejection, reducing reliance on endomyocardial biopsy.
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