Pathophysiology and diagnosis of allograft rejection in pediatric heart transplantation

Attempts at improving diagnostic monitoring of allograft rejection continue at a steady pace. The main issue remains whether these methods will replace the standard method of tissue histology from endomyocardial biopsy.

The aim in the development of novel techniques to diagnose rejection is the application of noninvasive methods. These range from echocardiography, biomarkers, and genomic profiling to more sensitive antibody detection systems. No single method has the accuracy to be a stand-alone test. Methods of assessing graft dysfunction alone may not be accurate enough in this population. Nonetheless, these and other clinical descriptive studies help us better understand the rejection process in pediatric recipients.

Solid organ transplantation creates the ideal medium where basic science meets clinical science. Clinical cardiology continues to improve on ways to assess organ dysfunction, but to correlate these methods to early graft rejection, immunobiologic techniques will probably need to be incorporated.