Modern diagnostics and treatment of heart transplant rejection
Teszák Tímea
Cardiovascular Medicine and Research Division
Dr. Merkely Béla
SE Városmajori Szív- és Érgyógyászati Klinika Nagy előadóterem
2026-09-10 11:00:00
Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Dr. Merkely Béla
Dr. Sax Balázs
Dr. Bohács Anikó
Dr. Borbély Attila
Dr. Horkay Ferenc
Dr. Wagner László
Dr. Ablonczy László
Heart transplantation has significantly improved the quality of life and survival of patients with advanced HF. Significant advances have been made in the diagnosis and treatment of HTx rejection. dd-cfDNA serves as a biomarker of graft injury, rising during episodes of acute rejection and demonstrating excellent negative predictive value. LVGLS and strain-derived myocardial work indices are emerging echocardiographic parameters with expanding clinical utility. ECP, which does not cause generalised immunosuppression, has been proposed as a therapy for HTx rejection.
First, we described the first clinical implementation of a local laboratory-run, commercially available dd-cfDNA assay-based molecular monitoring programme for routine HTx rejection surveillance. Second, we investigated whether reductions in LV longitudinal strain parameters could reflect early HTx injury, as assessed by dd-cfDNA (Rejection surveillance). Third, we evaluated the efficacy of ECP in combination with a tacrolimus-based maintenance immunosuppressive therapy for treating cardiac allograft rejection across various clinical scenarios (Rejection treatment).
Since October 2022, HTx recipients have been transitioned from our EMB-based rejection surveillance protocol to a monthly dd-cfDNA-guided monitoring strategy. The mean dd-cfDNA fraction remained low (0.13±0.06%). By November 2024, this strategy had eliminated 88% of otherwise indicated surveillance EMBs. dd-cfDNA is effective at excluding clinically significant acute rejection and reduces the need for invasive surveillance EMBs. No correlation was observed between dd-cfDNA and LVGLS. LVGLS appears less sensitive than dd-cfDNA for detecting early myocardial injury in low-risk HTx recipients. ECP was indicated for acute moderate-to-severe cellular rejection, persistent mild cellular rejection, or mixed rejection. When combined with conventional anti-rejection therapy, ECP effectively reversed cardiac allograft rejection, reduced the incidence of subsequent rejection episodes, and restored allograft function in patients who completed the treatment course. Methylprednisolone dose reduction was safely achieved throughout the ECP treatment period. ECP can be safely utilised alongside standard immunosuppressive regimens for both the treatment and prevention of cardiac allograft rejection.
