Treatment of allograft vasculopathy in heart transplantation.
Cardiac allograft vasculopathy remains one of the main causes of morbidity and mortality after heart transplantation, although its impact is becoming somewhat smaller as prophylactic measures are implemented. Advances in the understanding of the molecular and cellular mechanisms involved in the genesis and development of cardiac allograft vasculopathy are opening ways for new diagnostic and therapeutic strategies. Successful prophylaxis of the early stages of the disease has been demonstrated with the use of newer immunosuppressive agents, such as sirolimus and everolimus, that will probably be included in future protocols. For most patients with established cardiac allograft vasculopathy, currently available revascularisation methods and retransplantation are not appropriate options. Antiproliferative agents could provide significant improvement in terms of symptom relief and prognosis, but their definite value must be proven in well-designed trials.
Segovia
Javier
J
Unidad de Trasplante Cardiaco, Hospital Universitario Puerta de Hierro, C/S. Martín de Porres, 4, 28035 Madrid, Spain. jsecu@eresmas.net
Gómez-Bueno
Manuel
M
Alonso-Pulpón
Luis
L
D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D014184:Transplantation, Homologous; D014665:Vasodilator Agents / Q000627:therapeutic use
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D014665:Vasodilator Agents