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Non-invasive approaches for the diagnosis of acute cardiac allograft rejection
  1. Christopher A Miller1,2,3,
  2. James E Fildes1,4,
  3. Simon G Ray1,3,
  4. Helen Doran5,
  5. Nizar Yonan1,4,
  6. Simon G Williams1,3,
  7. Matthias Schmitt1,2
  1. 1North West Regional Heart Centre and Heart and Lung Transplant Unit, University Hospital of South Manchester, Wythenshawe, Manchester, UK
  2. 2Centre for Imaging Sciences & Biomedical Imaging Institute, University of Manchester, Manchester, UK
  3. 3Cardiovascular Research Group, University of Manchester, UK.
  4. 4Institute of Inflammation and Repair, The University of Manchester, Manchester, UK.
  5. 5Department of Pathology, University Hospital of South Manchester, Wythenshawe, Manchester, UK
  1. Correspondence to Dr Christopher A Miller, North West Regional Cardiac Centre and Heart and Lung Transplant Unit, University Hospital of South Manchester, Wythenshawe, Manchester M23 9LT, UK; chrismiller{at}


Despite modern immunosuppressive regimes, acute rejection remains a leading cause of morbidity and mortality in heart transplant recipients. Clinical features are unreliable, and therefore, screening is performed in order to detect rejection, and hence, augment immunosuppressive therapy, at an early stage, with the aim of reducing short- and long-term sequelae. Histological analysis of right ventricular myocardial tissue obtained at endomyocardial biopsy remains the ‘gold standard’ surveillance technique; however ‘biopsy-negative’ rejection occurs in up to 20% of patients, the procedure is associated with uncommon but potentially serious complications and it is expensive. Non-invasive screening would, conceivably, be safer, more tolerable and cheaper, and could potentially allow more comprehensive monitoring. The evidence for non-invasive methods of diagnosing acute rejection, including assessment of myocardial deformation, myocardial tissue characterisation, electrophysiological monitoring, visualisation of cellular and molecular components of rejection and peripheral monitoring of immune activation, is reviewed.

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