Heart Transplantation Rejection

Heart transplantation (HTx) is a procedure limited to patients with end-stage heart failure (HF) who remain symptomatic despite being on optimal medical and device therapy. Guidelines identifying potential HTx candidates were updated in 2016 by International Society for Heart and Lung Transplantation (ISHLT). Stringent selection criteria and immunosuppressive therapy post-transplantation have led to improved prognosis. Despite the progress and improved overall outcomes, heart transplantation rejection (HTR) remains the Achilles heel of transplantation. The manifestation of rejection can occur as early as intraoperatively to many years after transplant. The timing of HTR plays a significant role in establishing cause and diagnosis. Based on timings, HTR can either be due to early graft dysfunction, occurring within first 24 hours or late graft dysfunction developing weeks to years after transplantation.