Newer Immunosuppression and Strategies on the Horizon in Heart Transplantation

AbstractPurpose of ReviewBalanced immunosuppressive therapy is the key to long-term survival after allograft transplantation. With a worldwide median recipient/graft survival of more than 11  years, heart transplantation is a highly successful treatment for selected patients with end-stage heart failure. However, current immunosuppressive regimens are associated with adverse effects. In the balance between acute rejection, cardiac allograft vasculopathy, infections and an increased ris k of malignancy, there is room for improvement. The aim of this review article is to present an overview of immunosuppressive mechanisms and new immune therapy strategies in heart transplantation and to highlight emerging approaches in this field that may influence our immunosuppressive strategies i n the future.Recent FindingsCalcineurin inhibitors have been the central drug class in post-transplant immunosuppressive regimens. New trials have explored alternative drugs, such as inhibitors of mechanistic target of rapamycin and belatacept. There is ongoing research on the development of strategies to induce long-term allograft tolerance.SummaryThis review briefly introduces allograft rejection immunology, and sums up contemporary immunosuppressive strategies with emphasis on the development of calcineurin inhibitor-sparing regimens and the prospect of achieving long-term tolerance.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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Background. Two or more early rejections (1 y) have been associated with coronary artery vasculopathy (CAV) in pediatric heart transplant (HT) recipients. We hypothesized that clinical rejection defined by concurrent new-onset heart failure or left ventricular systolic dysfunction is more strongly associated with future CAV than rejection diagnosed on protocol biopsy. Methods. We identified all subjects
Source: Transplantation - Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research
CONCLUSIONS: CMV infection was not associated with impaired long-term prognosis after HT. PMID: 31806387 [PubMed - as supplied by publisher]
Source: Medicina Clinica - Category: General Medicine Tags: Med Clin (Barc) Source Type: research
AbstractPurpose of ReviewHeart transplant (HT) is the therapy of choice for patients with end-stage heart failure (HF), leading to substantial improvements in quality of life, functional status, and longevity compared to optimal medical therapy for end-stage HF. However, race/ethnic disparities in post-HT survival persist and remain a major concern. The purpose of this review is to describe differences in post-transplant outcomes based on race/ethnicity and to highlight evolving knowledge of the reasons for these persistent disparate outcomes.Recent FindingsBlack HT recipients have the highest risk for allograft failure an...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research
AbstractPurpose of ReviewThe purpose of this review is to provide a comprehensive update on recent advances in heart transplantation.Recent FindingsHeart transplantation is now an established therapy for end-stage heart failure, though challenges still exist. However, multiple advances over the past few years will improve the survival and quality of life of heart transplant recipients. These advances include acceptance of previously considered marginal donor hearts, revisions to the donor heart allocation policy, advances in desensitization regimens, tailoring of immunosuppression regimens, and improvement in the diagnosis...
Source: Current Heart Failure Reports - Category: Cardiology Source Type: research
Alterations in the partly microbiota-dependent carnitine-butyrobetaine ( γBB)- trimethylamine-N-oxide (TMAO) pathway have been linked to the progression of heart failure and atherosclerotic disease. We evaluated if circulating γBB, TMAO and their common precursors carnitine and trimethyllysine (TML) were dysregulated after heart transplantation and associated with deve lopment of cardiac allograft vasculopathy (CAV) and acute rejection.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Original Clinical Science Source Type: research
Alterations in the partly microbiota-dependent carnitine –γ-butyrobetaine (γBB)–trimethylamine N-oxide (TMAO) pathway have been linked to the progression of heart failure and atherosclerotic disease. We evaluated if circulating γBB, TMAO, and their common precursors carnitine and trimethyllysine (TML) were dysregulated after heart transplantation a nd associated with development of cardiac allograft vasculopathy (CAV) and acute rejection.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: ORIGINAL CLINICAL SCIENCE Source Type: research
We describe the case of a man with idiopathic nonischemic cardiomyopathy who, at age 17, was given an ABO- and size-matched heterotopic allograft that was a complete human leukocyte antigen mismatch. The graft functioned normally for 20 years until the patient had a myocardial infarction that necessitated placement of a coronary artery stent. Subsequent treatments involved many interventions, including insertion of an intra-aortic balloon pump, medical therapy for heart failure, implantation of a total artificial heart, and, ultimately, orthotopic transplantation. To our knowledge, our patient is the longest surviving reci...
Source: Texas Heart Institute Journal - Category: Cardiology Authors: Tags: Tex Heart Inst J Source Type: research
The rapid evolution in mechanical circulatory support technology has resulted in dramatic improvements in the treatment of heart failure in adults. Early survival after ventricular assist device (VAD) implantation is similar —in selected groups—to that after transplantation.1 There is an increasing recognition that, especially in the context of the dramatic imbalance between the prevalence of heart failure in adults and the availability of donor allografts, we are rapidly approaching the point at which for many adul t patients, long-term VAD support will offer better outcomes than transplantation.
Source: The Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Commentary Source Type: research
We present a 32-year-old man diagnosed with Danon disease; a nonsense mutation in the LAMP-2 gene. Progressive heart failure symptoms resulted in initial heart transplant at age 27 years. He subsequently developed severe cardiac allograft vasculopathy that led to graft failure requiring a redo orthotopic heart transplant. This is one of only two reported Danon disease cases described to date surviving repeat orthotopic heart transplants. We present this case to highlight the importance of heart transplantation in the management of Danon disease, to emphasize the risk of cardiac allograft vasculopathy post-transplant, and t...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
AbstractPurpose of ReviewThe goal of this review article is to highlight our understanding of potential complications after heart transplantation. We aim to discuss recent advances within the field that directly impact the management of heart transplant recipients. Our target audiences include cardiologists, emergency medicine, and internal medicine providers.Recent FindingsHeart transplantation remains definitive therapy for end-stage heart failure. Complications after transplant can be divided in to post-operative, early, and late. Complications are related to the differing physiology of the denervated transplant heart a...
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research
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