Heart transplantation (HTx) is a life-saving procedure for patients with end-stage heart failure, offering improved quality of life and survival rates. However, heart transplant rejection (HTR) remains a significant challenge, threatening the long-term success of this intervention. Rejection occurs when the recipient's immune system recognizes the transplanted heart as foreign and mounts an immune response against it. HTR can either be due to early graft dysfunction within the first 24 hours or late graft dysfunction, developing weeks to years after transplantation. In 2010, the International Society for Heart and Lung Transplantation (ISHLT) published its Guidelines for the Care of Heart Transplant Recipients. These guidelines represented the initial comprehensive framework for managing HTx. Since then, there have been numerous advancements and changes in the field. Stringent selection criteria and immunosuppressive therapy posttransplantation have led to improved prognosis. Despite advances in immunosuppressive therapies, which have significantly reduced acute rejection rates, chronic rejection and associated complications continue to pose risks.
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