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Review
. 2025 May-Jun;33(3):193-198.
doi: 10.1097/CRD.0000000000000596. Epub 2023 Aug 2.

Cardiac Allograft Rejection: Strategies for Success in the Face of Immune Challenges

Haris Patail  1 , Shazli Khan  2 , Chhaya Aggarwal-Gupta  2 , Wilbert S Aronow  2
Affiliations
Review

Cardiac Allograft Rejection: Strategies for Success in the Face of Immune Challenges

Haris Patail et al. Cardiol Rev. 2025 May-Jun.

Abstract

Heart transplantation for patients with end-stage heart failure refractory to medical therapy has remained definitive treatment with significant advances in posttransplant care. Despite improvement in postoperative morbidity and mortality, acute cellular rejection (ACR) and antibody-mediated rejection (AMR) remain substantial challenges that can lead to allograft failure and patient mortality. Immunosuppressive agents have been the mainstay of both prevention and treatment for ACR and AMR; however, many challenges exist with traditional therapies. There are a multitude of molecular pathways involved in mediating the humoral and cellular response to rejection, offering various targets for treatment. This review summarizes therapies used in the management of ACR and AMR as extrapolated from use in induction therapy and treatment of other solid-organ transplant rejection. Future studies focused on cardiac transplant recipients are needed to expand therapeutic options.

Keywords: acute cellular rejection; antibody-mediated rejection; heart transplant; immunosuppression.

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Conflict of interest statement

Disclosure: The authors have no conflicts of interest to report.

References

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