{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:14:35Z","timestamp":1790151275607,"version":"4.0.1"},"reference-count":86,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Heart transplantation is the gold standard treatment for end-stage heart failure. Despite immunosuppression as the cornerstone therapy for post-transplant management, the presence of immunological complications including acute cellular rejection (ACR), antibody-mediated rejection (AMR), and cardiac allograft vasculopathy (CAV)\u2014remain major barriers to long-term graft survival. Graft monitoring largely remains dependent on protocolized endomyocardial biopsy (EMBx), an invasive, risky procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Scope<\/jats:title>\n                    <jats:p>This narrative review focuses on aggregating the published evidence, summarizing key clinical complications, and presenting the available tools to date. Furthermore, we discuss key limitations which must be addressed to improve patient care, including the need for non-invasive biomarkers in cardiac allograft vasculopathy<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key findings<\/jats:title>\n                    <jats:p>Significant progress in the development and promising use of non-invasive biomarkers for the detection of graft rejection has emerged over the last decade; particularly for monitoring ACR and AMR. Donor-derived cell-free DNA and gene expression profiling of circulating immune cells have both emerged as promising tools to aide post-transplant management of graft health and reduce EMBx frequency. Soluble protein biomarkers\u2014including hs-cTn, BNP, and NT-proBNP\u2014provide supplementary information on graft stress and injury but lack specificity. In contrast, evidence supporting non-invasive biomarker use in CAV remains sparse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Non-invasive biomarkers have meaningfully advanced rejection surveillance in heart transplantation and hold promise for reducing procedural burden on patients. However, their role in detecting and monitoring CAV remains underdeveloped, and represents the most critical unmet need in the field.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1923304","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:56:23Z","timestamp":1790150183000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["From rejection to vasculopathy: a review of non-invasive biomarkers in alloimmune responses in heart transplantation"],"prefix":"10.3389","volume":"13","author":[{"given":"Paula","family":"Maj\u00f3 Ribera","sequence":"first","affiliation":[{"name":"Translational and Clinical Research Institute, Newcastle University","place":["Newcastle upon Tyne, United Kingdom"]},{"name":"Institute of Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust","place":["Newcastle upon Tyne, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Bates","sequence":"additional","affiliation":[{"name":"Translational and Clinical Research Institute, Newcastle University","place":["Newcastle upon Tyne, United Kingdom"]},{"name":"Institute of Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust","place":["Newcastle upon Tyne, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Scott","sequence":"additional","affiliation":[{"name":"Translational and Clinical Research Institute, Newcastle University","place":["Newcastle upon Tyne, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Fisher","sequence":"additional","affiliation":[{"name":"Translational and Clinical Research Institute, Newcastle University","place":["Newcastle upon Tyne, United Kingdom"]},{"name":"Institute of Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust","place":["Newcastle upon Tyne, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Gonzalez-Fernandez","sequence":"additional","affiliation":[{"name":"Translational and Clinical Research Institute, Newcastle University","place":["Newcastle upon Tyne, United Kingdom"]},{"name":"Institute of Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust","place":["Newcastle upon Tyne, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1857","DOI":"10.1016\/j.healun.2025.04.014","article-title":"The international thoracic organ transplant registry of the international society for heart and lung transplantation: 2025 annual report of heart and lung transplantation","volume":"44","author":"Singh","year":"2025","journal-title":"J Heart Lung Transplant"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1016\/j.healun.2019.08.004","article-title":"The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-sixth adult heart transplantation report\u20142019; focus theme: donor and recipient size match","volume":"38","author":"Khush","year":"2019","journal-title":"J Heart Lung Transplant"},{"key":"B3","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1097\/TP.0000000000002220","article-title":"ISHLT primary graft dysfunction incidence, risk factors, and outcome: a UK national study","volume":"103","author":"Avtaar Singh","year":"2019","journal-title":"Transplantation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"101504","DOI":"10.1016\/j.cpcardiol.2022.101504","article-title":"Trends, burden, and impact of arrhythmias on cardiac transplant recipients: a 16-year nationwide study","volume":"48","author":"Isath","year":"2023","journal-title":"Curr Probl Cardiol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.31661\/gmj.v12i.2701","article-title":"Early postoperative cardiac complications following heart transplantation","volume":"12","author":"Negargar","year":"2023","journal-title":"Galen Med J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"46","DOI":"10.3390\/medsci13020046","article-title":"Trends in heart transplantation and outcome analysis: nationwide study using the national inpatient sample and readmission database","volume":"13","author":"Varughese","year":"2025","journal-title":"Med Sci"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.healun.2022.10.015","article-title":"The international society for heart and lung transplantation (ISHLT) guidelines for the care of heart transplant recipients","volume":"42","author":"Velleca","year":"2023","journal-title":"J Heart Lung Transplant"},{"key":"B8","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.clinthera.2018.11.007","article-title":"Prevalence of medication nonadherence to co-medication compared to immunosuppressants in heart transplant recipients: findings from the international cross-sectional BRIGHT study","volume":"41","author":"Helmy","year":"2019","journal-title":"Clin Ther"},{"key":"B9","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1111\/j.1600-6143.2008.02495.x","article-title":"Nonadherence consensus conference summary report","volume":"9","author":"Fine","year":"2009","journal-title":"Am J Transplant"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2889","DOI":"10.1111\/ajt.15339","article-title":"Noninvasive detection of graft injury after heart transplant using donor-derived cell-free DNA: a prospective multicenter study","volume":"19","author":"Khush","year":"2019","journal-title":"Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2591","DOI":"10.1093\/eurheartj\/ehv682","article-title":"Clinical usefulness of gene-expression profile to rule out acute rejection after heart transplantation: CARGO II","volume":"37","author":"Crespo-Leiro","year":"2016","journal-title":"Eur Heart J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1016\/j.healun.2022.06.019","article-title":"Circulating microRNAs in cellular and antibody-mediated heart transplant rejection","volume":"41","author":"Shah","year":"2022","journal-title":"J Heart Lung Transplant Off Publ Int Soc Heart Transplant"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e70636","DOI":"10.1002\/ctm2.70636","article-title":"A novel integrated miRNA\u2013donor age signature enables detection of cardiac allograft vasculopathy","volume":"16","author":"Gonz\u00e1lez-Torrent","year":"2026","journal-title":"Clin Transl Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1016\/j.healun.2017.12.008","article-title":"Utility of troponin assays for exclusion of acute cellular rejection after heart transplantation: a systematic review","volume":"37","author":"Fitzsimons","year":"2018","journal-title":"J Heart Lung Transplant"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2118","DOI":"10.1016\/j.athoracsur.2011.07.048","article-title":"Soluble ST2 is a marker for acute cardiac allograft rejection","volume":"92","author":"Pascual-Figal","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e14616","DOI":"10.1111\/ctr.14616","article-title":"Suppression of tumorigenicity-2 (ST2) is a promising biomarker in heart transplantation","volume":"36","author":"Galeone","year":"2022","journal-title":"Clin Transplant"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1016\/j.healun.2020.06.011","article-title":"Circulating extracellular vesicles as non-invasive biomarker of rejection in heart transplant","volume":"39","author":"Castellani","year":"2020","journal-title":"J Heart Lung Transplant"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1540","DOI":"10.1097\/TP.0000000000005369","article-title":"Circulating tissue specific extracellular vesicles for noninvasive monitoring of acute cellular rejection in clinical heart transplantation","volume":"109","author":"Korutla","year":"2025","journal-title":"Transplantation"},{"key":"B19","doi-asserted-by":"publisher","first-page":"110659","DOI":"10.1016\/j.clim.2025.110659","article-title":"Systemic cytokine profiling enhances the performance of dd-cfDNA to detect cardiac rejection","volume":"283","author":"Andargie","year":"2026","journal-title":"Clin Immunol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"100446","DOI":"10.1016\/j.jhlto.2025.100446","article-title":"The role of high-sensitivity troponin in identifying patients with cardiac allograft rejection","volume":"11","author":"Scussel","year":"2026","journal-title":"JHLT Open"},{"key":"B21","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1161\/CIRCULATIONAHA.109.924167","article-title":"Comparative evaluation of left and right ventricular endomyocardial biopsy: differences in complication rate and diagnostic performance","volume":"122","author":"Yilmaz","year":"2010","journal-title":"Circulation"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1097\/TP.0b013e31826e19e2","article-title":"Concordance among pathologists in the second cardiac allograft rejection gene expression observational study (CARGO II)","volume":"94","author":"Crespo-Leiro","year":"2012","journal-title":"Transplantation"},{"key":"B23","doi-asserted-by":"publisher","first-page":"115","DOI":"10.3390\/jcdd11040115","article-title":"Ten-year experience with endomyocardial biopsy after orthotopic heart transplantation: comparison between trans-jugular and trans-femoral approach","volume":"11","author":"Galeone","year":"2024","journal-title":"J Cardiovasc Dev Dis"},{"key":"B24","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1016\/j.healun.2024.10.006","article-title":"Pathologist interrater reliability and clinical implications of elevated donor-derived cell-free DNA beyond heart transplant rejection, on behalf of the GRAfT investigators","volume":"44","author":"Mehta","year":"2025","journal-title":"J Heart Lung Transplant"},{"key":"B25","doi-asserted-by":"publisher","first-page":"R151","DOI":"10.1186\/cc11466","article-title":"Prognostic utility and characterization of cell-free DNA in patients with severe sepsis","volume":"16","author":"Dwivedi","year":"2012","journal-title":"Crit Care"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e69679","DOI":"10.7554\/eLife.69679","article-title":"The influence of biological and lifestyle factors on circulating cell-free DNA in blood plasma","volume":"10","author":"Yuwono","year":"2021","journal-title":"eLife"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e15477","DOI":"10.1111\/ctr.15477","article-title":"Clinical examples of the additive value of absolute quantification of cell-free DNA after heart transplantation","volume":"38","author":"B\u00f6hmer","year":"2024","journal-title":"Clin Transplant"},{"key":"B28","doi-asserted-by":"publisher","first-page":"S290","DOI":"10.1016\/j.healun.2021.01.824","article-title":"Allomap versus endomyocardial biopsy: the patient experience","volume":"40","author":"Jamil","year":"2021","journal-title":"J Heart Lung Transplant"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e70438","DOI":"10.1111\/ctr.70438","article-title":"Perspectives of heart transplant patients and providers on acute rejection surveillance: a mixed-methods study","volume":"40","author":"Kim","year":"2026","journal-title":"Clin Transplant"},{"key":"B30","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1016\/j.cardfail.2023.12.019","article-title":"The wallet biopsy: medical crowdfunding for heart transplantation","volume":"30","author":"Defilippis","year":"2024","journal-title":"J Card Fail"},{"key":"B31","doi-asserted-by":"publisher","first-page":"102354","DOI":"10.1016\/j.jaccas.2024.102354","article-title":"Breaking barriers","volume":"29","author":"Batista","year":"2024","journal-title":"JACC Case Rep"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1016\/j.healun.2005.03.019","article-title":"Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection","volume":"24","author":"Stewart","year":"2005","journal-title":"J Heart Lung Transplant"},{"key":"B33","first-page":"452","article-title":"Repetitive nontreated episodes of grade 1B or 2 acute rejection impair long-term cardiac graft function","volume":"14","author":"Anguita","year":"1995","journal-title":"J Heart Lung Transplant Off Publ Int Soc Heart Transplant"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1334","DOI":"10.1161\/01.CIR.94.6.1334","article-title":"Natural course of moderate cardiac allograft rejection (international society for heart transplantation grade 2) early and late after transplantation","volume":"94","author":"Rocca","year":"1996","journal-title":"Circulation"},{"key":"B35","doi-asserted-by":"publisher","first-page":"52","DOI":"10.3390\/jpm14010052","article-title":"Rejection requiring treatment within the first year following heart transplantation: the UNOS insight","volume":"14","author":"Gemelli","year":"2024","journal-title":"J Pers Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1159\/000510747","article-title":"Molecular mechanisms of antibody-mediated rejection and accommodation in organ transplantation","volume":"144","author":"Kenta","year":"2021","journal-title":"Nephron"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1016\/j.healun.2013.08.011","article-title":"The 2013 international society for heart and lung transplantation working formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation","volume":"32","author":"Berry","year":"2013","journal-title":"J Heart Lung Transplant"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1161\/CIR.0000000000000093","article-title":"Antibody-mediated rejection in cardiac transplantation: emerging knowledge in diagnosis and management: a scientific statement from the American Heart Association","volume":"131","author":"Colvin","year":"2015","journal-title":"Circulation"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1016\/j.healun.2016.04.007","article-title":"The effect of timing and graft dysfunction on survival and cardiac allograft vasculopathy in antibody-mediated rejection","volume":"35","author":"Clerkin","year":"2016","journal-title":"J Heart Lung Transplant"},{"key":"B40","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/j.cjca.2025.09.040","article-title":"New insights into pathogenesis, diagnosis, and management of cardiac allograft vasculopathy","volume":"42","author":"David","year":"2026","journal-title":"Can J Cardiol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"2225","DOI":"10.1007\/s00421-019-04207-5","article-title":"Autonomic cardiovascular control changes in recent heart transplant recipients lead to physiological limitations in response to orthostatic challenge and isometric exercise","volume":"119","author":"Nygaard","year":"2019","journal-title":"Eur J Appl Physiol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"S248","DOI":"10.1016\/j.healun.2020.01.535","article-title":"Micro and macrovascular cardiac allograft vasculopathy in relation to 92 cardiovascular biomarkers evaluated by a novel proximity extension assay in heart transplant recipients","volume":"39","author":"Bjerre","year":"2020","journal-title":"J Heart Lung Transplant"},{"key":"B43","doi-asserted-by":"publisher","first-page":"e14167","DOI":"10.1111\/ctr.14167","article-title":"Intravascular ultrasound for cardiac allograft vasculopathy detection","volume":"35","author":"Mendiz","year":"2021","journal-title":"Clin Transplant"},{"key":"B44","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1016\/j.jacc.2017.12.005","article-title":"Long-term sirolimus for primary immunosuppression in heart transplant recipients","volume":"71","author":"Asleh","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.atherosclerosis.2022.08.005","article-title":"Long-term efficacy of everolimus as de novo immunosuppressant on the cardiac allograft vasculopathy in heart transplant recipients","volume":"357","author":"Choi","year":"2022","journal-title":"Atherosclerosis"},{"key":"B46","doi-asserted-by":"publisher","first-page":"132455","DOI":"10.1016\/j.ijcard.2024.132455","article-title":"Incidence of de novo malignancy and all-cause mortality among heart transplant recipients","volume":"415","author":"Barrera","year":"2024","journal-title":"Int J Cardiol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"856","DOI":"10.1016\/j.ejcts.2008.02.014","article-title":"Survival analysis in heart transplantation: results from an analysis of 1290 cases in a single center","volume":"33","author":"Tjang","year":"2008","journal-title":"Eur J Cardiothorac Surg"},{"key":"B48","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1016\/j.athoracsur.2020.05.163","article-title":"Long-term survival after heart transplantation: a population-based nested case-control study","volume":"111","author":"Suarez-Pierre","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"B49","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1016\/j.cjca.2025.11.014","article-title":"Thriving long term after heart transplantation","volume":"42","author":"Alkhalaileh","year":"2026","journal-title":"Can J Cardiol"},{"key":"B50","doi-asserted-by":"publisher","first-page":"2","DOI":"10.3390\/cimb47010002","article-title":"Tacrolimus- and mycophenolate-mediated toxicity: clinical considerations and options in management of post-transplant patients","volume":"47","author":"Kaye","year":"2025","journal-title":"Curr Issues Mol Biol"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3007803","article-title":"Circulating cell-free DNA enables noninvasive diagnosis of heart transplant rejection","volume":"6","author":"De Vlaminck","year":"2014","journal-title":"Sci Transl Med"},{"key":"B52","doi-asserted-by":"publisher","first-page":"841849","DOI":"10.3389\/fimmu.2022.841849","article-title":"Assessment of acute rejection by global longitudinal strain and cardiac biomarkers in heart-transplanted patients","volume":"13","author":"Clemmensen","year":"2022","journal-title":"Front Immunol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"100774","DOI":"10.1016\/j.trre.2023.100774","article-title":"Diagnostic accuracy of brain natriuretic peptide and N-terminal-pro brain natriuretic peptide to detect complications of cardiac transplantation in adults: a systematic review and meta-analysis","volume":"37","author":"Zhu","year":"2023","journal-title":"Transplant Rev"},{"key":"B54","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1016\/j.amjcard.2004.04.060","article-title":"Usefulness of an elevated B-type natriuretic peptide to predict allograft failure, cardiac allograft vasculopathy, and survival after heart transplantation","volume":"94","author":"Mehra","year":"2004","journal-title":"Am J Cardiol"},{"key":"B55","doi-asserted-by":"publisher","first-page":"856600","DOI":"10.3389\/fcvm.2022.856600","article-title":"Lack of usefulness of donor-derived cell-free DNA as a biomarker for cardiac allograft vasculopathy: a prospective study","volume":"9","author":"Jim\u00e9nez-Blanco Bravo","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B56","doi-asserted-by":"publisher","first-page":"e15168","DOI":"10.1111\/ctr.15168","article-title":"High sensitivity troponin I as a biomarker for cardiac allograft vasculopathy: evaluation of diagnostic potential and clinical utility","volume":"38","author":"Patel","year":"2024","journal-title":"Clin Transplant"},{"key":"B57","doi-asserted-by":"publisher","first-page":"e70195","DOI":"10.1111\/ctr.70195","article-title":"Association of cardiovascular biomarkers with cardiac allograft vasculopathy and atherosclerotic coronary artery disease","volume":"39","author":"K\u00f6ster","year":"2025","journal-title":"Clin Transplant"},{"key":"B58","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/j.healun.2018.01.1291","article-title":"The management of antibodies in heart transplantation: an ISHLT consensus document","volume":"37","author":"Kobashigawa","year":"2018","journal-title":"J Heart Lung Transplant"},{"key":"B59","doi-asserted-by":"publisher","first-page":"e431","DOI":"10.1097\/TP.0000000000002333","article-title":"Understanding the correlation between DSA, complement activation, and antibody-mediated rejection in heart transplant recipients","volume":"102","author":"Zhang","year":"2018","journal-title":"Transplantation"},{"key":"B60","doi-asserted-by":"publisher","first-page":"102264","DOI":"10.1016\/j.trim.2025.102264","article-title":"Pre-transplant sensitization and its effect on heart transplant rejection and survival outcomes","volume":"92","author":"Shin","year":"2025","journal-title":"Transpl Immunol"},{"key":"B61","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1016\/j.healun.2016.10.016","article-title":"Donor-specific anti-HLA antibodies with antibody-mediated rejection and long-term outcomes following heart transplantation","volume":"36","author":"Clerkin","year":"2017","journal-title":"J Heart Lung Transplant"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.124.011592","article-title":"Redefining cardiac antibody-mediated rejection with donor-specific antibodies and graft dysfunction","volume":"17","author":"Goldberg","year":"2024","journal-title":"Circ Heart Fail"},{"key":"B63","doi-asserted-by":"publisher","first-page":"3731","DOI":"10.3390\/jcm11133731","article-title":"De novo complement-binding anti-HLA antibodies in heart transplanted patients is associated with severe cardiac allograft vasculopathy and poor long-term survival","volume":"11","author":"Baudry","year":"2022","journal-title":"J Clin Med"},{"key":"B64","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1309\/AJCPTLBEU5BQ8SHN","article-title":"Circulating donor-specific anti\u2013human leukocyte antigen antibodies and complement C4d deposition are associated with the development of cardiac allograft vasculopathy","volume":"142","author":"Frank","year":"2014","journal-title":"Am J Clin Pathol"},{"key":"B65","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1016\/j.healun.2022.04.002","article-title":"A novel donor-derived cell-free DNA assay for the detection of acute rejection in heart transplantation","volume":"41","author":"Kim","year":"2022","journal-title":"J Heart Lung Transplant"},{"key":"B66","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1161\/CIRCULATIONAHA.120.049098","article-title":"Cell-free DNA to detect heart allograft acute rejection","volume":"143","author":"Agbor-Enoh","year":"2021","journal-title":"Circulation"},{"key":"B67","doi-asserted-by":"publisher","first-page":"102716","DOI":"10.1016\/j.jchf.2025.102716","article-title":"Donor-derived cell-free DNA in antibody-mediated rejection","volume":"14","author":"Kim","year":"2026","journal-title":"JACC Heart Fail"},{"key":"B68","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1016\/j.ajt.2025.04.021","article-title":"A two-threshold algorithm using donor-derived cell-free DNA fraction and quantity to detect acute rejection after heart transplantation","volume":"25","author":"Kim","year":"2025","journal-title":"Am J Transplant"},{"key":"B69","doi-asserted-by":"publisher","first-page":"e14206","DOI":"10.1111\/ctr.14206","article-title":"Donor-derived cell-free DNA is associated with cardiac allograft vasculopathy","volume":"35","author":"Holzhauser","year":"2021","journal-title":"Clin Transplant"},{"key":"B70","doi-asserted-by":"publisher","first-page":"e15416","DOI":"10.1111\/ctr.15416","article-title":"Lack of association between donor-derived cell-free DNA and cardiac allograft vasculopathy","volume":"38","author":"Alharethi","year":"2024","journal-title":"Clin Transplant"},{"key":"B71","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1016\/j.healun.2021.12.006","article-title":"Higher levels of allograft injury in black patients early after heart transplantation","volume":"41","author":"Doshi","year":"2022","journal-title":"J Heart Lung Transplant"},{"key":"B72","doi-asserted-by":"publisher","first-page":"e038892","DOI":"10.1161\/JAHA.124.038892","article-title":"Racial disparities in heart transplantation: long-term graft survival and nonmortality outcomes","volume":"14","author":"Hamilton","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"B73","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1161\/CIRCULATIONAHA.116.022907","article-title":"Gene expression profiling for the identification and classification of antibody-mediated heart rejection","volume":"135","author":"Loupy","year":"2017","journal-title":"Circulation"},{"key":"B74","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.healun.2006.12.011","article-title":"Transplant vasculopathy is associated with increased AlloMap gene expression score","volume":"26","author":"Yamani","year":"2007","journal-title":"J Heart Lung Transplant"},{"key":"B75","doi-asserted-by":"publisher","first-page":"e0170842","DOI":"10.1371\/journal.pone.0170842","article-title":"Association of Serum MiR-142-3p and MiR-101-3p levels with acute cellular rejection after heart transplantation. Mari B, editor","volume":"12","author":"Sukma Dewi","year":"2017","journal-title":"PLoS One"},{"key":"B76","doi-asserted-by":"publisher","first-page":"e26","DOI":"10.1097\/TP.0000000000001477","article-title":"MicroRNA 628-5p as a novel biomarker for cardiac allograft vasculopathy","volume":"101","author":"Neumann","year":"2017","journal-title":"Transplantation"},{"key":"B77","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1097\/TP.0000000000004323","article-title":"The molecular microscope diagnostic system: assessment of rejection and injury in heart transplant biopsies","volume":"107","author":"Halloran","year":"2023","journal-title":"Transplantation"},{"key":"B78","doi-asserted-by":"publisher","first-page":"2443","DOI":"10.1111\/ajt.17087","article-title":"Evolving the surveillance and workup of heart transplant rejection: a real-world analysis of the molecular microscope diagnostic system","volume":"22","author":"Alam","year":"2022","journal-title":"Am J Transplant"},{"key":"B79","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1016\/j.healun.2025.12.002","article-title":"Enhanced detection of antibody-mediated rejection using the tissue-based molecular microscope diagnostic system (MMDx)","volume":"45","author":"Fernandez Valledor","year":"2026","journal-title":"J Heart Lung Transplant"},{"key":"B80","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1016\/j.healun.2024.02.011","article-title":"Relationship between donor-derived cell-free DNA and tissue-based rejection-related transcripts in heart transplantation","volume":"43","author":"Lee","year":"2024","journal-title":"J Heart Lung Transplant"},{"key":"B81","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1093\/eurheartj\/ehaf949","article-title":"Heart allograft rejection: molecular diagnosis using intra-graft targeted gene expression profiling","volume":"47","author":"Giarraputo","year":"2026","journal-title":"Eur Heart J"},{"key":"B82","doi-asserted-by":"publisher","first-page":"110720","DOI":"10.1016\/j.humimm.2023.110720","article-title":"Kinetics of torque teno virus in heart transplant patients","volume":"84","author":"Berg","year":"2023","journal-title":"Hum Immunol"},{"key":"B83","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.3390\/biomedicines11051410","article-title":"Torque teno virus load predicts opportunistic infections after kidney transplantation but is not associated with maintenance immunosuppression exposure","volume":"11","author":"Ca\u00f1amero","year":"2023","journal-title":"Biomedicines"},{"key":"B84","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1016\/j.jacc.2012.02.065","article-title":"Circulating apoptotic endothelial cells and apoptotic endothelial microparticles independently predict the presence of cardiac allograft vasculopathy","volume":"60","author":"Singh","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"B85","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/j.healun.2025.12.019","article-title":"Cardiac allograft vasculopathy in the era of precision medicine: the role of biomarkers and advanced imaging","volume":"45","author":"Kim","year":"2026","journal-title":"J Heart Lung Transplant"},{"key":"B86","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.cjca.2025.08.345","article-title":"Biomarker-Based surveillance in heart transplant rejection","volume":"42","author":"Etts","year":"2026","journal-title":"Can J Cardiol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1923304\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:56:24Z","timestamp":1790150184000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1923304\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":86,"alternative-id":["10.3389\/fmed.2026.1923304"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1923304","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]},"article-number":"1923304"}}