Advancements in noninvasive techniques for transplant rejection: from biomarker detection to molecular imaging

作者：Yuan Song, Yihui Wang, Wenyuan Wang, Yuji Xie, Junmin Zhang, Jing Liu, Qiaofeng Jin, Wenqian Wu, He Li, Jing Wang, Li Zhang, Yali Yang, Gao Tang, Mingxing Xie · 发表于：Journal of Translational Medicine · 年份：2025 · DOI：10.1186/s12967-024-05964-4 · 被引用次数：36 · 研究领域：Transplantation: Methods and Outcomes、Organ Transplantation Techniques and Outcomes、Renal Transplantation Outcomes and Treatments

Transplant rejection remains a significant barrier to the long-term success of organ transplantation. Biopsy, although considered the gold standard, is invasive, costly, and unsuitable for routine monitoring. Traditional biomarkers, such as creatinine and troponin, offer limited predictive value owing to their low specificity, and conventional imaging techniques often fail to detect early organ damage, increasing the risk of undiagnosed rejection episodes. Considering these limitations, emerging noninvasive biomarkers and molecular imaging techniques hold promise for the early and accurate detection of transplant rejection, enabling personalized management strategies. This review highlights noninvasive biomarkers that predict, diagnose, and assess transplant prognosis by reflecting graft injury, inflammation, and immune responses. For example, donor-derived cell-free DNA (dd-cfDNA) is highly sensitive in detecting early graft injury, whereas gene expression profiling effectively excludes moderate-to-severe acute rejection (AR). Additionally, microRNA (miRNA) profiling enhances the diagnostic specificity for precise AR detection. Advanced molecular imaging techniques further augment the monitoring of rejection. Fluorescence imaging provides a high spatiotemporal resolution for AR grading, ultrasound offers real-time and portable monitoring, and magnetic resonance delivers high tissue contrast for anatomical assessments. Nuclear imaging modalities such as single photon emission...