{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:01:28Z","timestamp":1787756488398,"version":"build-2784847793"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"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. Transplant."],"abstract":"<jats:p>\n                    Since the standardization of the grading system for pathologic diagnosis of antibody-mediated and acute cellular rejection, endomyocardial biopsy has remained the gold-standard. However, biopsies are invasive, costly, and limited by sampling error. As such, adjuvant non-invasive methods including cardiac biomarkers, imaging including cardiac magnetic resonance and echocardiography, and donor-specific antibodies and non-HLA antibodies have been traditionally used. However, all these techniques are limited by either sensitivity or specificity. More recently, there has been a shift to other contemporary non-biopsy surrogate markers for rejection surveillance including donor-derived cell free DNA, gene expression profiling, and messenger RNA and micro-RNA in tissue. Herein we review the methods currently utilized to diagnose rejection and their limitations. We find that while there have been significant advancements in technology and non-invasive techniques, no current method alone adequately diagnoses rejection (\n                    <jats:xref>Central Image<\/jats:xref>\n                    ). Thus, future studies are warranted to investigate new strategies involving a multi-modal approach that incorporates non-invasive diagnostic methods and personalized medicine to monitor postoperative progression in heart transplant patients.\n                  <\/jats:p>","DOI":"10.3389\/frtra.2025.1693821","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:54:02Z","timestamp":1769064842000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnosis of rejection following heart transplantation: diving into the future"],"prefix":"10.3389","volume":"4","author":[{"given":"Shaline","family":"Rao","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Zain","family":"Ali","sequence":"additional","affiliation":[{"name":"New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arushi","family":"Singh","sequence":"additional","affiliation":[{"name":"New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mittal","family":"Rana","sequence":"additional","affiliation":[{"name":"New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Moussa","sequence":"additional","affiliation":[{"name":"New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinza","family":"Ahmed","sequence":"additional","affiliation":[{"name":"New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Golob","sequence":"additional","affiliation":[{"name":"New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Cusumano","sequence":"additional","affiliation":[{"name":"New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alana","family":"Harrington","sequence":"additional","affiliation":[{"name":"New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Wang","sequence":"additional","affiliation":[{"name":"New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Chandrasekhar","sequence":"additional","affiliation":[{"name":"New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Alam","sequence":"additional","affiliation":[{"name":"New York University Long Island Grossman School of Medicine, NYU Langone Health","place":["Mineola, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"B1","first-page":"587","article-title":"A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: heart rejection study group. 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