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2025, Number 2

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Rev Fac Med UNAM 2025; 68 (2)

Heart Transplant: Which Studies Guarantee Its Survival?

Marcell RL

Language: Spanish
References: 35
Page: 8-25
PDF size: 433.33 Kb.


ABSTRACT

Heart failure is a significant health issue in many countries, and heart transplantation remains the only treatment capable of increasing the life expectancy of affected patients. For the transplanted heart to remain functional, both immunological and non-immunological compatibility must exist between the donor and the cardiac transplant candidate (CTC).
This review aims to provide a comprehensive update on histocompatibility studies and post-transplant follow-up. Pre-transplant histocompatibility assessments are limited to ABO blood group compatibility and the detection and characterization of antibodies against major histocompatibility complex (MHC) molecules (anti-HLA antibodies) in the CTC. Crossmatch testing is typically performed retrospectively due to time and logistical constraints.
Because HLA gene compatibility is not considered a criterion for heart allocation —as it is in other types of organ transplantation— the risk of developing donor-specific anti- HLA antibodies (DSAs) and triggering a cellular immune response leading to rejection is high. This necessitates close post-transplant follow-up.
To enable early rejection diagnosis, non-invasive methods are being employed alongside endomyocardial biopsy, which remains the “gold standard”. These methods include imaging studies, electrocardiograms, and peripheral blood biomarkers. Among these, established techniques such as antibody detection and characterization coexist with more innovative approaches, including T lymphocyte function assays and genomic medicine (gene expression profiling, donor-derived cell-free DNA, and microRNA detection).
Integrating HLA gene compatibility —particularly HLADR— into histocompatibility testing, alongside non-invasive post-transplant monitoring strategies, will help reduce rejection episodes and improve both graft and recipient survival.


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