[Monitoring and adjustment of immunosuppression after heart transplantation].
Heart transplantation remains the best therapeutic option for the treatment of end-stage heart failure. However, good survival rates can be obtained only if patients are closely monitored, particularly for their immunosuppressive regimens. Currently, a triple-drug regimen usually based on calcineurin-inhibitors (cyclosporin A or tacrolimus), anti-proliferative agents and steroids is used in most recipients. New agents such as the mTOR inhibitors, a more recently developed class of immunosuppressive drugs, can also be used in some patients. The aim of this article is to review currently used immunosuppressive regimens after heart transplantation, and to propose some individualized options depending on specific patient characteristics and recent pharmacological developments in the field.
Yerly
P
P
Département de médecine interne, CHUV, 1011 Lausane. patrick.yerly@chuv.ch
Mach
F
F
Kalangos
A
A
Rotman
S
S
von Segesser
L
L
Vogt
P
P
Hullin
R
R
Pascual
M
M
D002908:Chronic Disease; D002986:Clinical Trials as Topic; D016572:Cyclosporine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000008:administration & dosage; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D015201:Meta-Analysis as Topic; D015166:Monitoring, Immunologic / Q000379:methods*; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D011494:Protein Kinases / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000008:administration & dosage; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000187:drug effects*; D058570:TOR Serine-Threonine Kinases; D016559:Tacrolimus / Q000008:administration & dosage; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011494:Protein Kinases; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D009173:Mycophenolic Acid; D020123:Sirolimus; D016559:Tacrolimus