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Cell-free DNA in the surveillance of heart transplant rejection

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

Circulating cell-free deoxyribonucleic acid (cfDNA) is promptly materializing as a highly useful tool for the surveillance of solid-organ transplant rejection. Donor-specific fraction (DF) cfDNA is a potential marker of selective donor organ injury. It is emerging as a promising analytical target in the near future. The aim of this systematic review is to throw light on the importance of cfDNA and future perspective in detecting acute rejection in heart transplantation.

Methods

An exhaustive search was carried out for this review article on the basis of literature available including scientific databases of PubMed, Embase, and ClinicalTrials.gov. The search engines were systematically explored using the search terms “cell free DNA,” “Heart transplant,” and “Rejection” from inception until August 2020, and narrative analysis was accomplished. Majority of the studies described endomyocardial biopsy-proven acute rejection as reference standard.

Results

After initial screening of 331 articles, 11 studies were included and discussed in detail in the present review article. Majority of the studies showed prospective designs. A firm correlation was noted between acute rejection (identified on endomyocardial biopsy) and cfDNA levels by most of the studies.

Conclusions

cfDNA is a promising tool to replace repeated biopsies to detect rejection. The development in the area of digital droplet polymerase chain reaction and massive parallel sequencing, along with the overall reduction in cost of sequencing with its automation, has helped establish its role in the transplant population.

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Data availability

All data used in the analysis are already available in the literature, and data sources are reported in the article.

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Authors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, SMS Medical College & Attached Hospitals, J L N Marg, Jaipur, Rajasthan, 302001, India

    Dhruva Sharma

  2. Institute of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare, No. 72, Nelson Manickam Road, Aminjikarai, Chennai, Tamil Nadu, 600029, India

    Ganapathy Subramaniam

  3. Department of Pharmacology, SMS Medical College & Attached Hospitals, J L N Marg, Jaipur, Rajasthan, 302001, India

    Neha Sharma

  4. Department of Anatomy, SMS Medical College & Attached Hospitals, J L N Marg, Jaipur, Rajasthan, 302001, India

    Preksha Sharma

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Correspondence to Neha Sharma.

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This manuscript represents a review article. Because this project involved no experimental design, Institutional Review Board approval was not required. Applicable EQUATOR Network (http://www.equator-network.org) guidelines were followed.

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This prospective search was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020199218).

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Sharma, D., Subramaniam, G., Sharma, N. et al. Cell-free DNA in the surveillance of heart transplant rejection. Indian J Thorac Cardiovasc Surg 37, 257–264 (2021). https://doi.org/10.1007/s12055-020-01130-9

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  • DOI: https://doi.org/10.1007/s12055-020-01130-9

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