Treatment of nonhemodynamic compromising rejection: conventional approaches vs individualization/new immunosuppressive drugs.
Mild rejection may be treated with an increase in oral CyA, but most centers give no therapy and perform a follow-up endomyocardial biopsy within 2 weeks of rejection. Focal moderate rejection is treated similarly to mild rejection; however, there is controversy as to whether focal moderate rejection exists. Asymptomatic moderate rejection is usually treated with an increase in steroids, either i.v. or oral. The therapy for asymptomatic moderate rejection is quite variable and dependent on cardiac hemodynamics, the degree of lymphocytic infiltrates, the interval after heart transplantation, and clinical findings. Symptomatic moderate rejection or severe rejection should be treated with a combination of increased steroids and cytolytic therapy. Other forms of therapy under study may provide more effective methods of treating rejection in the future.
Kobashigawa
J A
JA
University of California-Los Angeles, School of Medicine, UCLA Heart Transplant Program, USA.
D000917:Antibody Formation; D016572:Cyclosporine / Q000627:therapeutic use*; D006084:Graft Rejection / Q000145:classification / Q000188:drug therapy* / Q000276:immunology; D016027:Heart Transplantation / Q000276:immunology* / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D013256:Steroids / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine