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Selection and Interpretation of Molecular Diagnostics in Heart Transplantation.
Goldberg, Jason F; Truby, Lauren K; Agbor-Enoh, Sean; Jackson, Annette M; deFilippi, Christopher R; Khush, Kiran K; Shah, Palak.
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  • Goldberg JF; Department of Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church, VA (J.F.G., C.R.d., P.S.).
  • Truby LK; Department of Pediatrics, Inova L.J. Murphy Children's Hospital, Falls Church, VA (J.F.G.).
  • Agbor-Enoh S; Department of Medicine, University of Texas Southwestern, Dallas (L.K.T.).
  • Jackson AM; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (S.A.-E.).
  • deFilippi CR; Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda, MD (S.A.-E.).
  • Khush KK; Department of Surgery, Duke University School of Medicine, Durham, NC (A.M.J.).
  • Shah P; Department of Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church, VA (J.F.G., C.R.d., P.S.).
Circulation ; 148(8): 679-694, 2023 08 22.
Article en En | MEDLINE | ID: mdl-37603604
The number of heart transplants performed annually in the United States and worldwide continues to increase, but there has been little change in graft longevity and patient survival over the past 2 decades. The reference standard for diagnosis of acute cellular and antibody-mediated rejection includes histologic and immunofluorescence evaluation of endomyocardial biopsy samples, despite invasiveness and high interrater variability for grading histologic rejection. Circulating biomarkers and molecular diagnostics have shown substantial predictive value in rejection monitoring, and emerging data support their use in diagnosing other posttransplant complications. The use of genomic (cell-free DNA), transcriptomic (mRNA and microRNA profiling), and proteomic (protein expression quantitation) methodologies in diagnosis of these posttransplant outcomes has been evaluated with varying levels of evidence. In parallel, growing knowledge about the genetically mediated immune response leading to rejection (immunogenetics) has enhanced understanding of antibody-mediated rejection, associated graft dysfunction, and death. Antibodies to donor human leukocyte antigens and the technology available to evaluate these antibodies continues to evolve. This review aims to provide an overview of biomarker and immunologic tests used to diagnose posttransplant complications. This includes a discussion of pediatric heart transplantation and the disparate rates of rejection and death experienced by Black patients receiving a heart transplant. This review describes diagnostic modalities that are available and used after transplant and the landscape of future investigations needed to enhance patient outcomes after heart transplantation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Corazón / Patología Molecular Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Child / Humans Idioma: En Revista: Circulation Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Corazón / Patología Molecular Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Child / Humans Idioma: En Revista: Circulation Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos