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Heart Transplant Immunosuppression Strategies at Cedars-Sinai Medical Center

Heart transplant is the optimal treatment for selected patients with end-stage heart failure. Immunosuppression after heart transplantation has significantly reduced the incidence of rejection and improved patient outcomes with the routine use of calcineurin inhibitors. Antimetabolites and prolifera...

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Autores principales: Chang, David H., Youn, Jong-Chan, Dilibero, Deanna, Patel, Jignesh K., Kobashigawa, Jon A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Heart Failure 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9536714/
https://www.ncbi.nlm.nih.gov/pubmed/36263111
http://dx.doi.org/10.36628/ijhf.2020.0034
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author Chang, David H.
Youn, Jong-Chan
Dilibero, Deanna
Patel, Jignesh K.
Kobashigawa, Jon A.
author_facet Chang, David H.
Youn, Jong-Chan
Dilibero, Deanna
Patel, Jignesh K.
Kobashigawa, Jon A.
author_sort Chang, David H.
collection PubMed
description Heart transplant is the optimal treatment for selected patients with end-stage heart failure. Immunosuppression after heart transplantation has significantly reduced the incidence of rejection and improved patient outcomes with the routine use of calcineurin inhibitors. Antimetabolites and proliferation signal inhibitors add to the improvement in patient outcomes as well. The goal of induction therapy is to provide intense immunosuppression when the risk of allograft rejection is highest. Most maintenance immunosuppressive protocols employ a 3-drug regimen consisting of a calcineurin inhibitor, an antimetabolite agent and glucocorticoids. The management of rejection proceeds in a stepwise fashion based on the severity of rejection detected on biopsy and the patient's clinical presentation. This review will cover induction, maintenance, rejection therapy and some special considerations including sensitization, renal sparing protocol, and corticosteroid weaning. It will end in consideration of potential future directions in immunosuppressive strategies to promote patient and graft survival.
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spelling pubmed-95367142022-10-18 Heart Transplant Immunosuppression Strategies at Cedars-Sinai Medical Center Chang, David H. Youn, Jong-Chan Dilibero, Deanna Patel, Jignesh K. Kobashigawa, Jon A. Int J Heart Fail Review Article Heart transplant is the optimal treatment for selected patients with end-stage heart failure. Immunosuppression after heart transplantation has significantly reduced the incidence of rejection and improved patient outcomes with the routine use of calcineurin inhibitors. Antimetabolites and proliferation signal inhibitors add to the improvement in patient outcomes as well. The goal of induction therapy is to provide intense immunosuppression when the risk of allograft rejection is highest. Most maintenance immunosuppressive protocols employ a 3-drug regimen consisting of a calcineurin inhibitor, an antimetabolite agent and glucocorticoids. The management of rejection proceeds in a stepwise fashion based on the severity of rejection detected on biopsy and the patient's clinical presentation. This review will cover induction, maintenance, rejection therapy and some special considerations including sensitization, renal sparing protocol, and corticosteroid weaning. It will end in consideration of potential future directions in immunosuppressive strategies to promote patient and graft survival. Korean Society of Heart Failure 2020-09-29 /pmc/articles/PMC9536714/ /pubmed/36263111 http://dx.doi.org/10.36628/ijhf.2020.0034 Text en Copyright © 2021. Korean Society of Heart Failure https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Chang, David H.
Youn, Jong-Chan
Dilibero, Deanna
Patel, Jignesh K.
Kobashigawa, Jon A.
Heart Transplant Immunosuppression Strategies at Cedars-Sinai Medical Center
title Heart Transplant Immunosuppression Strategies at Cedars-Sinai Medical Center
title_full Heart Transplant Immunosuppression Strategies at Cedars-Sinai Medical Center
title_fullStr Heart Transplant Immunosuppression Strategies at Cedars-Sinai Medical Center
title_full_unstemmed Heart Transplant Immunosuppression Strategies at Cedars-Sinai Medical Center
title_short Heart Transplant Immunosuppression Strategies at Cedars-Sinai Medical Center
title_sort heart transplant immunosuppression strategies at cedars-sinai medical center
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9536714/
https://www.ncbi.nlm.nih.gov/pubmed/36263111
http://dx.doi.org/10.36628/ijhf.2020.0034
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