The utilization of molecular microscope in management of heart transplant recipients in the era of noninvasive monitoring

• Published in: Clinical transplantation Vol. 37; no. 12; pp. e15131 - n/a
• Main Authors: Mehlman, Yonatan, Valledor, Andrea Fernendez, Moeller, Cathrine, Rubinstein, Gal, Lotan, Dor, Rahman, Salwa, Oh, Kyung T., Bae, David, DeFilippis, Ersilia M., Lin, Edward F., Lee, Sun Hi, Raikhelkar, Jayant K., Fried, Justin, Theodoropoulos, Kleanthis, Colombo, Paolo C., Yuzefpolskaya, Melana, Latif, Farhana, Clerkin, Kevin J., Sayer, Gabriel T., Uriel, Nir
• Format: Journal Article
• Language: English
• Published: Denmark 01-12-2023
• Subjects: ddcf‐DNA; endomyocardial biopsy; GEP; heart transplant; MMDx; molecular microscope; noninvasive; rejection; MMDx; molecular microscope; GEP; noninvasive; endomyocardial biopsy; heart transplant; ddcf-DNA; rejection
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.15131

Introduction
Monitoring for graft rejection is a fundamental tenet of post‐transplant follow‐up. In heart transplantation (HT) in particular, rejection has been traditionally assessed with endomyocardial biopsy (EMB). EMB has potential complications and noted limitations, including interobserver variability in interpretation. Additional tests, such as basic cardiac biomarkers, cardiac imaging, gene expression profiling (GEP) scores, donor‐derived cell‐free DNA (dd‐cfDNA) and the novel molecular microscope diagnostic system (MMDx) have become critical tools in rejection surveillance beyond standard EMB.
Methods
This paper describes an illustrative case followed by a review of MMDx within the context of other noninvasive screening modalities for rejection.
Conclusions
We suggest MMDx be used to assist with early detection of rejection in cases of discordance between EMB and other noninvasive studies.