Noninvasive diagnosis of acute cardiac allograft rejection

Purpose of review Endomyocardial biopsy has been used for the last 25 years to screen patients for acute cellular cardiac allograft rejection. Limited by invasiveness, complexity, discomfort, complication proneness, interpretation variability, late detection of rejection and cost, the value of protocol endomyocardial biopsy as a screening method for patients at low risk of rejection has been questioned. Here, we review the latest evidence on noninvasive methods in the management of patients following cardiac transplantation. Recent findings Noninvasive modalities have been investigated recently as potential substitutes for endomyocardial biopsy. After completion of the human genome project, high-throughput transcriptomic methods rapidly spread to the field of transplantation. A molecular, gene expression-based classifier was developed and validated against endomyocardial biopsy as a screening test for rejection. Summary Endomyocardial biopsy is considered the standard method of surveillance for acute cardiac allograft rejection. The CARGO study was the first multicenter study to develop, validate and verify a gene expression profiling test to discriminate acute cellular cardiac allograft rejection from quiescence. The initial clinical experience reproduced the findings from CARGO and the first randomized clinical trial comparing conventional biopsy-based against gene expression profiling-based strategy is ongoing.