Novel therapeutic and diagnostic management of heart transplant patients.
Heart transplantation was performed for the first time 40 years ago and it is now universally considered the "gold standard" treatment for individuals suffering from end-stage heart failure. The increased understanding of the molecular mechanisms and of the role of the immune system in allograft rejection led to an overall improvement of graft survival, which is now around 10 years. The introduction of novel immunosuppressive drugs reduced the rate of acute allograft rejection but did not improve significantly the long-term graft survival. In addition, adverse effects (e.g. infections, cancer and renal failure) associated with immunosuppressive drugs are increasing over time and may affect post-transplantation outcomes. An immunosuppression-free protocol based on tolerance induction is the Holy Grail for heart transplant recipients, but it is still far beyond our reach. In this review, we discuss the landscape of immunological challenges that heart transplanted individuals face and we critically review the novel immunological approaches available to overcome these remaining issues. Some of the novel approaches, successfully tested in preclinical and clinical models, may lead to a prolongation of patient's and heart allograft survival.
Transplant Medicine, IRCCS, Ospedale San Raffaele, Milan, Italy.|Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Francesca
F
D'Addio
Transplant Medicine, IRCCS, Ospedale San Raffaele, Milan, Italy.
Davide
D
Margonato
Transplant Medicine, IRCCS, Ospedale San Raffaele, Milan, Italy.
Umberto
U
Pensato
Cardiovascular Department, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy.
Laura
L
Borgese
Cardiovascular Department, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy.
Luciano
L
Potena
Transplant Medicine, IRCCS, Ospedale San Raffaele, Milan, Italy.|Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Paolo
P
Fiorina
allograft survival; chronic allograft vasculopathy; chronic rejection; heart transplantation; immunosuppression; tolerance