NONINVASIVE DIAGNOSIS OF HEART REJECTION AS A PREDICTOR OF LONG-TERM TRANSPLANT SURVIVAL

Abstract

Background. Currently, in Kazakhstan, the issue of chronic heart failure is becoming increasingly relevant, with high mortality from the terminal stage of chronic heart failure, especially in patients with III-IV functional class. Heart transplantation represents the "gold" standard of surgical treatment for terminal chronic heart failure, but endomyocardial biopsy, used for monitoring the transplanted heart, is an invasive and inconvenient procedure. Aim of this study is to generate data which can aid in more precise antibody-mediated rejection diagnosis, assisting in distinguishing between antibody-mediated rejectionand acute cellular rejection and helping us determine the appropriate treatment strategy Materials and Methods. This article explores the potential of safe and accurate monitoring of acute transplant rejection using circulating donor-derived cell-free DNA(dd-cfDNA). The study included 40 patients who underwent heart transplantation. Results. It was found that 60% of them had a repeat operation, while 40% had a primary one. Various cardiomyopathies, predominantly dilated and ischemic, were the cause of terminal chronic heart failure. The donor-derived cell-free DNA method demonstrates potential in differentiating T-cell-mediated and antibody-mediated rejection, with different patterns donor-derived cell-free DNA elevation. These differences have high clinical significance for diagnosis and treatment tactics. Conclusion. Despite the prospects of using donor-derived cell-free DNA, further research is needed to establish threshold values and confirm its effectiveness in clinical practice.