New advances in antirejection therapy.
OBJECTIVE
The prevention and treatment of rejection have been the major focus of clinical and research studies since the inception of heart transplantation. Recent improvement in survival after transplant has been in large part due to continued advancement in antirejection therapies.


RESULTS
The combination of steroids/cyclosporine/azathioprine has been widely used since the early 1980s. The last decade has seen the increasing use of the drugs mycophenolate mofetil and tacrolimus. Newer agents such as target of rapamycin protein inhibitors and anti-interleukin-2 inhibitors have come under intense research recently, and may play a significant role in heart transplantation. Further study is required for agents such as rituximab. With the recent introduction of a new grading of cardiac allograft rejection, controversy remains over when rejection should be treated and which agents should be used.


CONCLUSIONS
Use of newer proven antirejection drugs has reduced rejection and improved survival after heart transplantation. Rejection and side effects from these drugs are still major problems, however; therefore continued research in this area is required.
Chan
Michael
M
Heart Transplant Program, University of Alberta Hospitals, Edmonton, Alberta, Canada. mcchan@cha.ab.ca
Pearson
Glen J
GJ
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D065095:Calcineurin Inhibitors; D000068338:Everolimus; D006084:Graft Rejection / Q000188:drug therapy / Q000517:prevention & control*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069283:Rituximab; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D000068338:Everolimus; D020123:Sirolimus; D016559:Tacrolimus