The Future of Heart Transplantation

Gene Expression Profiling for the Identification and Classification of Antibody-Mediated Heart Rejection

“…Personalized medicine 42 has gained momentum in the transplantation field. 5,43 The improvement of knowledge regarding rejection pathophysiology together with the implementation of technologies has led to the emergence of new potential biomarker candidates for predicting allograft rejection. 19,44 In recent years, the field of kidney transplantation has moved to molecular medicine with growing evidence that molecular techniques applied to biopsies 45 and urine analysis 46,47 could be useful for both investigating biopsies and screening patients at risk for allograft rejection in a non-invasive manner.…”

“…Identifying non-invasive and reliable biomarkers for screening heart transplant rejection is one of the major challenges of solid organ transplantation. 5 While attempts have been made to isolate such biomarkers using peripheral blood gene expression in low-risk heart transplant recipients, this question is still unanswered. 6,7 A recent breakthrough has occurred with the discovery of small and non-coding RNAs called microRNAs that regulate gene expression.…”

The Past, Present and Future of Heart Transplantation

“…Cardiac denervation after HTx is clinically important because it explains why recipients are unable to experience angina due to ischemia, but may have bradycardia and hypotension related to inferior wall infarction post-HTx. 34) 43) 44) Cardiac denervation is also responsible for diminished exercise capacity early post-HTx, and is related to a slower increase in heart rate during exercise because the heart relies on non-cardiac circulating catecholamines. Cardiac denervation also explains loss of the nocturnal decline in blood pressure, and the higher resting heart rate early post-HTx.…”

“…Atropine and digoxin have no effect on the denervated heart and should not be used to treat arrhythmias in heart transplant patients. 34) 43) 44) …”

Clinical potential of DNA methylation in organ transplantation

“…12,13 The predictive value of these assays is now explored, with additional validation being necessary before clinical implementation. 4,14 Biomarkers for the diagnosis and/or prediction of posttransplant complications should be accurate with high specificity and high sensitivity, and results should be reproducible. The goal is to find biomarkers that display changes at the molecular level as an early indicator for these post-transplant complications, before the clinical signs appear, as this may prevent irreversible tissue damage.…”