The End of Endomyocardial Biopsy?: A Practical Guide for Noninvasive Heart Transplant Rejection Surveillance

Luise Holzhauser; Ersilia M DeFilippis; Andriana Nikolova; Mirnela Byku; Johanna P Contreras; Teresa De Marco; Shelley Hall; Kiran K Khush; Amanda R Vest

doi:10.1016/j.jchf.2022.11.002

The End of Endomyocardial Biopsy?: A Practical Guide for Noninvasive Heart Transplant Rejection Surveillance

JACC Heart Fail. 2023 Mar;11(3):263-276. doi: 10.1016/j.jchf.2022.11.002. Epub 2023 Jan 11.

Authors

Luise Holzhauser¹, Ersilia M DeFilippis², Andriana Nikolova³, Mirnela Byku⁴, Johanna P Contreras⁵, Teresa De Marco⁶, Shelley Hall⁷, Kiran K Khush⁸, Amanda R Vest⁹

Affiliations

¹ Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
² Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
³ Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁴ Department of Cardiology, University of North Carolina in Chapel Hill, North Carolina, USA.
⁵ Mount Sinai Hospital, New York, New York, USA.
⁶ Division of Cardiology, University of California, San Francisco, California, USA.
⁷ Baylor University Medical Center, Dallas, Texas, USA.
⁸ Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
⁹ Tufts Medical Center, Boston, Massachusetts, USA. Electronic address: avest@tuftsmedicalcenter.org.

PMID: 36682960
DOI: 10.1016/j.jchf.2022.11.002

Abstract

Noninvasive heart transplant rejection surveillance using gene expression profiling (GEP) to monitor immune activation is widely used among heart transplant programs. With the new development of donor-derived cell-free DNA (dd-cfDNA) assays, more programs are transitioning to a predominantly noninvasive rejection surveillance protocol with a reduced frequency of endomyocardial biopsies. As a result, many practical questions arise that potentially delay implementation of these valuable new tools. The purpose of this review is to provide practical guidance for clinicians transitioning toward a less invasive acute rejection monitoring protocol after heart transplantation, and to answer 10 common questions about the GEP and dd-cfDNA assays. Evidence supporting GEP and dd-cfDNA testing is reviewed, as well as guidance on test interpretation and future directions.

Keywords: biomarker; biopsy; dd-cfDNA; gene expression profiling; heart transplant; rejection.

Publication types

Review

MeSH terms

Biopsy
Cell-Free Nucleic Acids* / genetics
Graft Rejection / diagnosis
Heart Failure*
Heart Transplantation*
Humans
Postoperative Complications
Tissue Donors

Substances

Cell-Free Nucleic Acids