Bahniwal Rupinder K, Mehta Aditya, Kennedy Jamie L W
Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Falls Church, VA, United States.
Front Transplant. 2025 Aug 14;4:1623514. doi: 10.3389/frtra.2025.1623514. eCollection 2025.
Despite significant advances in organ preservation, surgical techniques, and immunosuppressive regimens, rejection continues to pose a major challenge in the care of heart transplant patients. Endomyocardial biopsy (EMB) remains the gold standard test for surveillance and diagnosis of rejection, but is limited by its invasiveness, interobserver variability, procedural risk, and cost thus prompting the widespread use of non-invasive biomarkers such as donor-derived cell-free DNA (dd-cfDNA). Due to its high negative predictive value, dd-cfDNA is often routinely used for surveillance of asymptomatic patients. However, it is a non-specific marker of allograft injury and elevated levels in the presence of a reassuring EMB creates a diagnostic dilemma. This review explores the pathophysiological basis and clinical utility of dd-cfDNA in monitoring of heart transplant recipients with particular focus on evaluation and management of discordant findings.
尽管在器官保存、手术技术和免疫抑制方案方面取得了重大进展，但排斥反应仍然是心脏移植患者护理中的一个主要挑战。心内膜心肌活检（EMB）仍然是监测和诊断排斥反应的金标准测试，但受到其侵入性、观察者间差异、操作风险和成本的限制，因此促使非侵入性生物标志物如供体来源的游离DNA（dd-cfDNA）的广泛使用。由于其高阴性预测价值，dd-cfDNA通常被常规用于无症状患者的监测。然而，它是同种异体移植物损伤的非特异性标志物，在EMB结果令人放心的情况下水平升高会造成诊断困境。本综述探讨了dd-cfDNA在监测心脏移植受者中的病理生理基础和临床应用，特别关注不一致结果的评估和管理。
