Rejet en transplantation cardiaque : au-delà du C4d, les nouveaux marqueurs biologiques, immunologiques et cellulaires

Abstract : Cardiac transplantation is currently the only option for long-term treatment for patients with terminal heart failure. Despite considerable advances in immunosuppressive therapy, allograft rejection remains a major cause of graft loss. In this regard, recent studies have highlighted the importance of antibody-mediated rejection (AMR) as an important contributory factor in the evolution of vascular graft disease and, ultimately, graft loss. The cornerstone of the rejection diagnosis is based on endomyocardial biopsy (EMB) and the classical histopathological evaluation. However, rejection episodes observed today are becoming scarce and more complex than before, due to the presence of truncated, indolent and mixed forms preventing an accurate diagnosis with a conventional assessment. In addition, the biopsy is an invasive procedure, resulting in significant costs, discomfort for the patient and a significant risk of serious complications. Therefore, conventional histological assessment does not reflect the complexity of cardiac transplant rejection and needs improvement in terms of diagnosis. The work presented in this thesis explores two types of biomarkers, the mTOR pathway, an in situ marker, and the micro-RNAs, circulating markers that would allow a better classification of rejection and provide diagnosis and/or predictive help to daily clinical practice during the monitoring of transplant patients.
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Marion Tible. Rejet en transplantation cardiaque : au-delà du C4d, les nouveaux marqueurs biologiques, immunologiques et cellulaires. Cardiologie et système cardiovasculaire. Université René Descartes - Paris V, 2014. Français. ⟨NNT : 2014PA05S009⟩. ⟨tel-01088048⟩

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