Zhou Leon, Wolfson Aaron, Vaidya Ajay S
Department of Cardiology, Keck School of Medicine, Los Angeles, California, USA.
Curr Opin Organ Transplant. 2022 Feb 1;27(1):45-51. doi: 10.1097/MOT.0000000000000953.
Long-term success of heart transplantation is limited by allograft rejection and cardiac allograft vasculopathy (CAV). Classic management has relied on frequent invasive testing to screen for early features of rejection and CAV to allow for early treatment. In this review, we discuss new developments in the screening and prevention of allograft rejection and CAV.
Newer noninvasive screening techniques show excellent sensitivity and specificity for the detection of clinically significant rejection. New biomarkers and treatment targets continue to be identified and await further studies regarding their utility in preventing allograft vasculopathy.
Noninvasive imaging and biomarker testing continue to show promise as alternatives to invasive testing for allograft rejection. Continued validation of their effectiveness may lead to new surveillance protocols with reduced frequency of invasive testing. Furthermore, these noninvasive methods will allow for more personalized strategies to reduce the complications of long-term immunosuppression whereas continuing the decline in the overall rate of allograft rejection.
心脏移植的长期成功受到移植物排斥反应和心脏移植物血管病变（CAV）的限制。传统管理方式依赖频繁的侵入性检查来筛查排斥反应和CAV的早期特征，以便进行早期治疗。在本综述中，我们讨论移植物排斥反应和CAV筛查与预防方面的新进展。
更新的非侵入性筛查技术在检测具有临床意义的排斥反应方面显示出优异的敏感性和特异性。新的生物标志物和治疗靶点不断被发现，有待进一步研究它们在预防移植物血管病变中的效用。
非侵入性成像和生物标志物检测作为移植物排斥反应侵入性检测的替代方法，继续展现出前景。对其有效性的持续验证可能会带来减少侵入性检查频率的新监测方案。此外，这些非侵入性方法将允许采用更个性化的策略来减少长期免疫抑制的并发症，同时继续降低移植物排斥反应的总体发生率。
