Surrogate markers of rejection.
OBJECTIVE
There is continued interest in defining viable noninvasive alternatives to endomyocardial biopsy (EMB) for monitoring recipients of orthotopic heart transplantation for episodes of rejection. This review summarizes the evidence of clinical utility for both available and emerging surrogate markers of rejection.


RESULTS
A variety of imaging modalities and peripheral biomarkers has been evaluated for this purpose and to date have had inadequate accuracy to replace EMB. Gene expression profile analysis is the most promising complementary technology to emerge, but there is insufficient clinical trial evidence at this time to allow gene expression profile as a substitution for EMB in all but a select group of patients.


CONCLUSIONS
The gold standard at this time for routine surveillance of orthotopic heart transplantation rejection remains EMB. However, on the basis of recent clinical trial results, gene expression profile analysis appears to be a useful adjunctive tool in monitoring for rejection and may permit a significant reduction in the frequency of EMB in low-risk patients.
Austin
Bethany A
BA
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Taylor
David O
DO
D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003952:Diagnostic Imaging; D020869:Gene Expression Profiling; D005819:Genetic Markers; D005820:Genetic Testing; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000235:genetics / Q000473:pathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D011237:Predictive Value of Tests
D015415:Biomarkers; D005819:Genetic Markers