Immunosuppression for heart transplantation: where are we now?
Kobashigawa JA; Patel JK UCLA Heart Transplant Program, Division of Cardiology, The David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. jonk@mednet.ucla.edu The success of cardiac transplantation is largely attributable to the development of effective immunosuppressive regimens. The introduction of calcineurin inhibitors was pivotal in reducing the frequency of acute rejection and improving early survival. Newer agents, including mycophenolate mofetil (MMF) and proliferation-signal inhibitors, have shown promise in further reducing acute-rejection rates and, notably, reducing the frequency of cardiac allograft vasculopathy, which limits long-term graft survival. The introduction of first-year intravascular ultrasonography results as a surrogate marker for outcome after cardiac transplantation has helped assessment of the efficacy of immunosuppressive medications. Proliferation-signal inhibitors and MMF were shown by this imaging method to reduce cardiac allograft vascu
