Khush Kiran K
Stanford University School of Medicine, Stanford, California.
J Heart Lung Transplant. 2021 Jun;40(6):397-404. doi: 10.1016/j.healun.2021.01.1564. Epub 2021 Feb 4.
Surveillance of allograft health after transplantation has traditionally relied on biopsy procedures that enable pathologic assessment for acute rejection. Noninvasive methods to assess for graft injury have been developed and tested over the past decade, and now offer a convenient way to reduce reliance on invasive testing and improve patient satisfaction. Emerging evidence suggests that detection of allograft injury via donor-derived cell-free DNA (dd-cfDNA) may, in fact, have better sensitivity compared to traditional biopsy-based strategies. This state-of-the-art review describes the development, testing, and current use of dd-cfDNA assays for acute rejection monitoring after heart transplantation, and discusses innovative ways that such assays can be used for personalized patient management.
传统上，移植后同种异体移植物健康状况的监测依赖于活检程序，这些程序能够对急性排斥反应进行病理评估。在过去十年中，已经开发并测试了评估移植物损伤的非侵入性方法，现在这些方法提供了一种便捷的方式来减少对侵入性检测的依赖并提高患者满意度。新出现的证据表明，与传统的基于活检的策略相比，通过供体来源的游离DNA（dd-cfDNA）检测同种异体移植物损伤实际上可能具有更高的灵敏度。这篇前沿综述描述了用于心脏移植后急性排斥反应监测的dd-cfDNA检测方法的开发、测试和当前应用，并讨论了这些检测方法可用于个性化患者管理的创新方式。
