The use of proliferation signal inhibitors in the prevention and treatment of allograft vasculopathy in heart transplantation.
Cardiac allograft vasculopathy (CAV) currently represents one of the most important causes of long-term morbidity and mortality in the heart transplant population. In well-designed studies with de novo patients, the use of proliferation signal inhibitors (PSIs; everolimus and sirolimus) has been shown to significantly prevent the intimal growth of graft coronary arteries in comparison to other immunosuppressive regimens, reducing the incidence of vasculopathy at 12 and 24 months. In addition, conversion to PSIs in maintenance patients with established CAV has also shown promising results in the reduction of the progression of the disease and its clinical consequences. For these reasons the interest shown by various transplantation units in the potential role of PSIs in this field is growing. The aim of the present article is to review the information obtained to date on the use of PSIs in heart transplant recipients, both in the prevention and the treatment of CAV. The principal published recommendations on the introduction and appropriate management of these drugs in clinical practice are also collected, as well as certain recommendations given by the authors based on their experience.
Delgado
Juan F
JF
Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital 12 de Octubre, 28041 Madrid, Spain. jdelgado.hdoc@salud.madrid.org
Manito
Nicolás
N
Segovia
Javier
J
Almenar
Luis
L
Arizón
José M
JM
Campreciós
Marta
M
Crespo-Leiro
Maria G
MG
Díaz
Beatriz
B
González-Vílchez
Francisco
F
Mirabet
Sònia
S
Palomo
Jesús
J
Roig
Eulàlia
E
de la Torre
José M
JM
D002455:Cell Division / Q000187:drug effects; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000517:prevention & control / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000517:prevention & control; D015398:Signal Transduction / Q000187:drug effects*; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents