Is Endomyocardial Biopsy Essential for the Follow-Up of Heart Transplantation?

pp. 233-238

Abstract

Endomyocardial biopsy is considered the gold standard for diagnosing and monitoring acute heart transplant rejection. However, due to its invasiveness and limitations, alternative diagnostic methods have emerged, the most developed being gene expression profiling and the detection of donor-derived cell-free DNA (liquid biopsy).

Both methods enable rejection surveillance beyond the initial months post-transplant. Their use individually, and especially in combination, has shown promising results. Their primary strength lies in their high negative predictive value, allowing for effective rejection exclusion.

Nevertheless, further work is needed to establish standardized cut-off points, validate these methods in unselected populations and at earlier transplant stages, improve access to these techniques, and conduct larger studies using clinically meaningful endpoints.