Immunosuppression following heart transplantation: prospects and challenges.
Immunosuppression after heart transplantation has significantly reduced the incidence of cellular rejection and improved patient outcomes with the routine use of calcineurin inhibitors. Antimetabolites and proliferation signal inhibitors add to the improvement in patient outcomes, particularly with respect to the reduced burden of cardiac allograft vasculopathy. Patients with antibody sensitization are potentially at higher risk of postoperative complications. Sensitized patients are undergoing heart transplantation with increased frequency, in part due to the emergence of ventricular assist device use as a bridge to heart transplantation. Despite improvements in immunosuppressive therapies, many challenges face physicians and patients, which will further refine and improve care of the post-heart transplant patient.
Cedars Sinai Heart Institute, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.
David H
DH
Chang
Michelle M
MM
Kittleson
Jon A
JA
Kobashigawa
D000818:Animals; D000963:Antimetabolites / Q000627:therapeutic use*; D065095:Calcineurin Inhibitors; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006131:Growth Inhibitors / Q000627:therapeutic use*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D007114:Immunization; D007165:Immunosuppression Therapy / Q000379:methods / Q000639:trends
D000963:Antimetabolites; D065095:Calcineurin Inhibitors; D006131:Growth Inhibitors