*Teaching Points:
• Historically surveillance for allograft rejection relied on endomyocardial biopsy which is invasive and subject to sampling limitations
• Contemporary allograft rejection surveillance protocols integrate cardiac MRI with molecular diagnostics such as donor-specific antibody testing, gene expression profiling (GEP), and donor-derived cell-free DNA (dd-cfDNA) to enhance early rejection detection and improve patient outcomes
• Understanding the imaging features of different rejection types, including acute cellular rejection (ACR), antibody-mediated rejection (AMR), and cardiac allograft vasculopathy (CAV), is essential
*Table of Contents/Outline:
1. Introduction
Epidemiology and survival trends in heart transplantation
Importance of rejection surveillance due to non-specific symptoms
2. Types of Rejection
Overview of ACR, AMR, and CAV
Pathophysiology and clinical implications
3. Traditional vs. Emerging Surveillance Strategies
Limitations of endomyocardial biopsy
Advances in non-invasive testing and their role in modern protocols
4. Cardiac MRI in Transplant Rejection
Imaging protocols and sequences
Characteristic findings for each type of rejection
Role in differentiating rejection from other pathologies
5. Case-Based Review
Illustrative cases demonstrating MRI findings and correlation with clinical, non-invasive molecular tests, and biopsy data
6. Integration into Clinical Practice
Contemporary algorithms for rejection surveillance
Multimodal approach incorporating imaging and molecular diagnostics
7. Conclusion and Future Directions
Cardiac MRI as a cornerstone of non-invasive transplant rejection monitoring

Yas Moayedi

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