Mehlman Yonatan, Valledor Andrea Fernendez, Moeller Cathrine, Rubinstein Gal, Lotan Dor, Rahman Salwa, Oh Kyung T, Bae David, DeFilippis Ersilia M, Lin Edward F, Lee Sun Hi, Raikhelkar Jayant K, Fried Justin, Theodoropoulos Kleanthis, Colombo Paolo C, Yuzefpolskaya Melana, Latif Farhana, Clerkin Kevin J, Sayer Gabriel T, Uriel Nir
Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA.
Clin Transplant. 2023 Dec;37(12):e15131. doi: 10.1111/ctr.15131. Epub 2023 Oct 28.
Monitoring for graft rejection is a fundamental tenet of post-transplant follow-up. In heart transplantation (HT) in particular, rejection has been traditionally assessed with endomyocardial biopsy (EMB). EMB has potential complications and noted limitations, including interobserver variability in interpretation. Additional tests, such as basic cardiac biomarkers, cardiac imaging, gene expression profiling (GEP) scores, donor-derived cell-free DNA (dd-cfDNA) and the novel molecular microscope diagnostic system (MMDx) have become critical tools in rejection surveillance beyond standard EMB.
This paper describes an illustrative case followed by a review of MMDx within the context of other noninvasive screening modalities for rejection.
We suggest MMDx be used to assist with early detection of rejection in cases of discordance between EMB and other noninvasive studies.
监测移植排斥反应是移植后随访的基本原则。特别是在心脏移植（HT）中，传统上通过心内膜心肌活检（EMB）来评估排斥反应。EMB存在潜在并发症和明显局限性，包括观察者间解释的差异。其他检测方法，如基本心脏生物标志物、心脏成像、基因表达谱（GEP）评分、供体来源的游离DNA（dd-cfDNA）和新型分子显微镜诊断系统（MMDx），已成为标准EMB之外排斥反应监测的关键工具。
本文描述了一个典型病例，随后在其他非侵入性排斥反应筛查方式的背景下对MMDx进行了综述。
我们建议在EMB与其他非侵入性研究结果不一致的情况下，使用MMDx协助早期检测排斥反应。
