title: The use of proliferation signal inhibitors in the prevention and treatment of allograft vasculopathy in heart transplantation.
abstract: 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.
authors.affiliation: Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital 12 de Octubre, 28041 Madrid, Spain. jdelgado.hdoc@salud.madrid.org
authors.forename: Juan F
authors.initials: JF
authors.lastname: Delgado
authors.forename: Nicolás
authors.initials: N
authors.lastname: Manito
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia
authors.forename: Luis
authors.initials: L
authors.lastname: Almenar
authors.forename: José M
authors.initials: JM
authors.lastname: Arizón
authors.forename: Marta
authors.initials: M
authors.lastname: Campreciós
authors.forename: Maria G
authors.initials: MG
authors.lastname: Crespo-Leiro
authors.forename: Beatriz
authors.initials: B
authors.lastname: Díaz
authors.forename: Francisco
authors.initials: F
authors.lastname: González-Vílchez
authors.forename: Sònia
authors.initials: S
authors.lastname: Mirabet
authors.forename: Jesús
authors.initials: J
authors.lastname: Palomo
authors.forename: Eulàlia
authors.initials: E
authors.lastname: Roig
authors.forename: José M
authors.initials: JM
authors.lastname: de la Torre
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents