Gene expression profiling and cardiac allograft rejection monitoring: Is IMAGE just a mirage?

Time-dependent risk of cardiac rejection requires dynamic surveillance strategies: The 3 distinct periods of immunologic adjustment (early), allograft adaptation, and then the stable phase of allograft maintenance require distinct vigilance strategies. Early on, a very concerted and aggressive strategy is required while adjustment of immunosuppression is underway. In Months 2 to 6, as allograft adaptation ensues, risk stratification for intense vs less intense strategies may be needed, perhaps guided by the predictive ability of gene-expression testing. In the maintenance phase, a clinical and functional evaluation structured approach may be adequate.