Key result
Newer immunosuppressive agents like sirolimus and everolimus show promise for prophylaxis of cardiac allograft vasculopathy, though their definite value requires confirmation in well-designed trials.
This review highlights the emerging role of newer immunosuppressive and antiproliferative agents in managing cardiac allograft vasculopathy post-heart transplantation.
Should not alter post-transplant immunosuppression; leaves open a role for sirolimus or everolimus pending definitive trials.
Cardiac allograft vasculopathy remains one of the main causes of morbidity and mortality after heart transplantation, although its impact is becoming somewhat smaller as prophylactic measures are implemented. Advances in the understanding of the molecular and cellular mechanisms involved in the genesis and development of cardiac allograft vasculopathy are opening ways for new diagnostic and therapeutic strategies. Successful prophylaxis of the early stages of the disease has been demonstrated with the use of newer immunosuppressive agents, such as sirolimus and everolimus, that will probably be included in future protocols. For most patients with established cardiac allograft vasculopathy, currently available revascularisation methods and retransplantation are not appropriate options. Antiproliferative agents could provide significant improvement in terms of symptom relief and prognosis, but their definite value must be proven in well-designed trials.
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Segovia et al. (2006) conducted a review in Cardiac allograft vasculopathy. Immunosuppressive and antiproliferative agents (e.g., sirolimus, everolimus) was evaluated. Newer immunosuppressive agents like sirolimus and everolimus show promise for prophylaxis of cardiac allograft vasculopathy, though their definite value requires confirmation in well-designed trials.
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