Precision Immunosuppression in Heart Transplantation: Biomarker-Guided Therapy Comes of Age

PURPOSE OF REVIEW: Heart transplantation is the definitive treatment for end-stage heart failure. While the number of heart transplant performed yearly in the United States has nearly doubled in the last decade, median survival has stagnated, largely due to the complications posed by lifelong immunosuppression. A shift towards precision medicine is needed to achieve the optimal balance between risk of allograft rejection and drug-related toxicities to improve post-transplant outcomes. RECENT FINDINGS: Novel molecular based diagnostic tools and biomarkers are being investigated, and hold promise in evaluating graft health and assessing immune state. The use of circulating biomarkers and molecular diagnostics such as human and viral cell-free DNA, tissue-based gene expression profiling, and circulating microRNAs, will allow for more comprehensive assessment of post-transplant immune activity and rejection risk to personalize patient care.