title: Multidisciplinary insights on clinical guidance for the use of proliferation signal inhibitors in heart transplantation.
abstract: Proliferation signal or mammalian target-of-rapamycin inhibitors (PSI/mTOR inhibitors), everolimus and sirolimus, provide attractive options for use in heart transplantation because they are immunosuppressive and anti-proliferative. PSI/mTOR inhibitors work synergistically with calcineurin inhibitors (CNIs) and thus permit the minimization of CNIs without compromising efficacy. This approach is advantageous for the majority of heart transplant recipients and might provide particular benefit in specific cases, such as patients with cardiac allograft vasculopathy, malignancies and renal dysfunction, or in patients intolerant to other immunosuppressive agents. Drawing on the expertise of transplant cardiologists, cardiac surgeons and nephrologists, we addressed the assessment of renal function; management of adverse events associated with this class of drugs; and clinical guidance, specifically for the use of everolimus, including patient selection, indications for treatment and practicalities of drug initiation and monitoring.
authors.affiliation: Department of Cardio-Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zuckermann
authors.forename: Nicolas
authors.initials: N
authors.lastname: Manito
authors.forename: Eric
authors.initials: E
authors.lastname: Epailly
authors.forename: Arnt
authors.initials: A
authors.lastname: Fiane
authors.forename: Christoph
authors.initials: C
authors.lastname: Bara
authors.forename: Juan F
authors.initials: JF
authors.lastname: Delgado
authors.forename: Hans
authors.initials: H
authors.lastname: Lehmkuhl
authors.forename: Heather
authors.initials: H
authors.lastname: Ross
authors.forename: Howard
authors.initials: H
authors.lastname: Eisen
authors.forename: Jeremy
authors.initials: J
authors.lastname: Chapman
authors.forename: Hannah
authors.initials: H
authors.lastname: Valantine
mesh_terms: D000068338:Everolimus; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D033183:Interdisciplinary Communication; D007677:Kidney Function Tests; D008297:Male; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011507:Proteinuria / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D020123:Sirolimus / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D013530:Surgical Wound Infection / Q000139:chemically induced / Q000453:epidemiology; D014181:Transplantation Immunology / Q000502:physiology; D014945:Wound Healing / Q000187:drug effects
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus