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This editorial refers to ‘MicroRNAs as non-invasive biomarkers of heart transplant rejection’[†][1], by J.-P.D. Van Huyen et al ., on page 3192. Patients' life expectancy after heart transplant (HTX) has increased tremendously since the first human transplantion in 1967.1 This has been achieved by refined surgical techniques, advances in organ preservation and dramatic improvements in immunosuppressive therapies, delivered as a collective effort by multiple clinical and scientific disciplines. One of the most important areas that nowadays require further improvement in the optimization of clinical outcome is patient care following transplantation.2 In general, the aim of post-operative care is to deliver adequate immunosuppression, prevent graft injury and rejection, and minimise the side effects and toxicity of drugs, guided by systematic monitoring of organ functions, clinical symptoms, therapeutic drug concentrations and biopsy results. Acute cardiac allograft rejection (ACAR) occurs in approximately 30% of cardiac transplant patients during the first year and at a rate of 1–7% per year thereafter.3,4 Optimization of the therapy is challenging; none of the existing diagnostic tools are able to predict clinical outcomes that could reliably guide therapeutic decisions. To overcome this, novel biomarkers are being developed that have adequate predictive potential; these biomarkers could complement or replace current diagnostic tools. Although it is invasive and costly, and false negative results are not uncommon, the 'gold standard' tool is still endomyocardial biopsy (EMB). Clinical indicators such as electrocardiogram (ECG) and imaging techniques (echocardiography, MRI) have been relatively unsuccessful in providing additional diagnostic or prognostic benefits. Biochemical markers of cardiomyocyte injury and stress, as well as inflammation, have also been assessed; these biomarkers have been measured mostly … [1]: #fn-2

Towards novel theranostic approaches in cardiac transplantation medicine