Importance of mammalian target of rapamycin inhibitors in the prevention of cardiac allograft vasculopathy

Purpose of review This review discusses the use of mammalian target of rapamycin inhibitors in cardiac transplantation. Recent findings Two major trials of mammalian target of rapamycin inhibitors in cardiac transplantation have been published in the past 9 months, confirming their promise as antirejection agents. More importantly, a potent preventive influence on transplantation vasculopathy has been shown. Both sirolimus and everolimus significantly reduced acute rejection and cytomegalovirus infection, and they reduced transplantation vasculopathy both early, and also at 2 years, as determined by intracoronary ultrasonography. Summary Although refinements to the use of mammalian target of rapamycin inhibitors are required to diminish the magnitude of interaction with calcineurin inhibitors and other drugs, these unique benefits will ensure their early adoption into clinical practice after heart transplantation.