Congestive heart failure affects about 23 million people worldwide, and cardiac allograft transplantation remains one of the last options for patients with terminal refractory heart failure. Besides the infectious or oncological complications, the prognosis of patients after heart transplantation is affected by acute cellular or antibody-mediated rejection and allograft vasculopathy development. Current monitoring of both conditions requires the performance of invasive procedures (endomyocardial biopsy sampling and coronary angiography or optical coherence tomography, respectively) that are costly, time-demanding, and non-comfortable for the patient. Within this narrative review, we focus on the potential pathophysiological and clinical roles of microRNAs (miRNAs, miRs) in the field of cardiac allograft transplantation. Firstly, we provide a general introduction about the status of cardiac allograft function monitoring and the discovery of miRNAs as post-transcriptional regulators of gene expression and clinically relevant biomarkers found in the extracellular fluid. After this general introduction, information from animal and human studies are summarized to underline the importance of miRNAs both in the pathophysiology of the rejection process, the possibility of its modulation by altering miRNAs levels, and last but not least, about the use of miRNAs in the clinical practice to diagnose or predict the rejection occurrence.

2nd Department of Internal Medicine St Anne's University Hospital and Faculty of Medicine Masaryk University Pekařská 53 65691 Brno Czech Republic

Central European Institute of Technology Masaryk University Kamenice 5 A35 625 00 Brno Czech Republic

Department of Biology Faculty of Medicine Masaryk University Kamenice 5 625 00 Brno Czech Republic

Department of Cardiovascular Diseases St Anne's University Hospital and Faculty of Medicine Masaryk University Pekařská 53 65691 Brno Czech Republic

Department of Pathological Physiology Faculty of Medicine Masaryk University Kamenice 5 A18 625 00 Brno Czech Republic

RECETOX Faculty of Sciences Masaryk University Kamenice 5 A29 625 00 Brno Czech Republic

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