2025 HFSA Contemporary Issues in Heart Failure - OnDemand-Non Invasive Methods

Video Transcription

Video Summary

Dr. Kiran Kush from Stanford University discusses noninvasive molecular diagnostics for detecting acute rejection post-heart transplantation. Traditional biopsies detect rejection late, have sampling errors, and carry procedural risks. Molecular tests, such as gene expression profiling (Allomap) and donor-derived cell-free DNA (dd-cfDNA) assays (like Alloshore), offer safer, earlier, and more sensitive detection of graft injury, including both cellular and antibody-mediated rejection. The CARGO and IMAGE studies validated gene expression testing’s non-inferiority to biopsies. dd-cfDNA assays quantify donor DNA in recipient blood, rising with graft injury, and enabling early rejection detection. Combining these molecular tests improves acute rejection detection and reduces unnecessary biopsies. Recent data from the SHORE registry showed dual positive molecular results predict worse outcomes even when biopsies are negative, indicating prognostic potential. Despite promise, challenges remain regarding validation, cost, and accessibility. Overall, molecular diagnostics enhance heart transplant monitoring by enabling personalized, noninvasive, and more accurate rejection surveillance.

Keywords

noninvasive molecular diagnostics

acute heart transplant rejection

gene expression profiling

donor-derived cell-free DNA

Allomap and Alloshore assays

heart transplant monitoring