[Diagnosis of rejection after heart transplantation].
By the development of immunosuppressants since the clinical use of cyclosporine in 1980s, the combination of various immunosuppressants such as cyclosporine or tacrolimus, azathioprine or mycophenolate mofetil, and steroid has been tried for the prevention of rejection. Acute rejection, however, has been still the second highest cause of death in the early stage post-tansplantation. Endomyocardial biopsy provides the diagnosis of acute cellular rejection, and its classification was recently revised; 0 (no rejection), 1R (mild rejection), 2R (moderate rejection), and 3R (severe rejection). Echocardiography has also provided helpful information not only for detecting acute rejection but also judgment of the recovery from it especially in pediatric patients. Cardiac allograft vasculopathy, that is, chronic rejection has been a main cause of death in the late stage post-tansplantation. As this involves entire coronary arteries from epicardial to distal portion in the myocardium, the diagnosis only by coronary angiogram is not sufficient, and the measurement of coronary flow reserve and/or intravascular ultrasound provide diagnostic information. m-TOR inhibitors such as sirolimus or everolimus are being used with increasing frequency following heart transplantation due to their potent immunosuppressive and antiproliferative effects. In clinical trials in de novo and maintenance heart transplant recipients, m-TOR inhibitors are associated with a reduced incidence of cardiac allograft vasculopathy when compared with alternative immunosuppressive regimens.
Nunoda
Shinichi
S
Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004452:Echocardiography; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000473:pathology; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009206:Myocardium / Q000473:pathology*; D014184:Transplantation, Homologous; D018084:Ultrasonography, Interventional
D007166:Immunosuppressive Agents