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Cardiac Allograft Rejection

  • Living reference work entry
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Book cover Contemporary Heart Transplantation

Part of the book series: Organ and Tissue Transplantation ((OTT))

  • 137 Accesses

Abstract

Cardiac transplantation has been largely successful due to current effective immunosuppressive regimens; however, despite improvements in immunosuppression and overall longevity of the cardiac allograft, acute rejection still poses a risk for poor out comes. Newer agents hold promise in reducing further acute and chronic rejection episodes including cardiac allograft vasculopathy. Endomyocardial biopsy remains the gold standard to diagnose acute rejection, but its invasive nature and repetitive use during posttransplant surveillance pose risk for complications. Noninvasive diagnostic studies of acute rejection are feasible with newer imaging modalities holding promise in early detection of rejection. Gene expression analysis, donor cell DNA, and cardiac MRI can be strong auxiliary methods to determine risk for rejection. Contemporary treatment of acute rejection episodes has improved due to our understanding of the immunological pathways involved in cellular- and antibody-mediated rejection. Chronic rejection however remains a challenge to treat due to interplay of complex immune mechanisms. This chapter will review the immunology of rejection, the diagnosis of cardiac allograft rejection determined by endomyocardial biopsy, and other novel noninvasive modalities and the treatment of rejection.

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Acknowledgments

The authors thank Dr. Grace Y. Lin, Associate Professor, from the Department of Pathology at UC San Diego Health, for providing the pathology slides.

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Authors and Affiliations

  1. Advanced Heart Failure, Mechanical Circulatory Support and Heart Transplant Program, University of California, San Diego, CA, USA

    Jorge Silva Enciso

  2. Cardiovascular Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Gurpreet Sodhi

  3. Heart Failure Program and Mechanical Circulatory Support Program, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Gurusher Panjrath

  4. Advanced Heart Failure, LVAD and Heart Transplant Program, University of California, San Diego, CA, USA

    Jorge Silva Enciso

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  1. Jorge Silva Enciso
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  2. Gurpreet Sodhi
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  3. Gurusher Panjrath
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Correspondence to Jorge Silva Enciso .

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Editors and Affiliations

  1. Cardiac, Vascular and Thoracic Surgery, Inova Fairfax Hospital, Falls Church, VA, VA, USA

    Linda Bogar

  2. Heart Failure/Transplant Cardiologist, The Cleveland Clinic Foundation, Cleveland, OH, OH, USA

    Maria Mountis

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Silva Enciso, J., Sodhi, G., Panjrath, G. (2019). Cardiac Allograft Rejection. In: Bogar, L., Mountis, M. (eds) Contemporary Heart Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-33280-2_22-1

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