Should We Develop a New Approach to Long-Term Immunosuppression?
Because long-term therapy and complications have not changed in the past 2 decades, perhaps we should be developing a more thoughtful approach to heart transplant management; an initial approach that addresses early immunosuppressant needs and infectious complications until baseline therapy and acceptable graft tolerance is achieved; and a different, evolving strategy to address the long-term consequences of CAV, renal insufficiency, and malignancy. Could this be a magic bullet? The report by Raichlin and coworkers1 on using sirolimus for primary immunosuppression is unique and noteworthy in this regard. By substituting sirolimus for CNI ≥3 years after transplantation, the burden of CAV as judged by intravascular ultrasound was substantially reduced. Treatment with azathioprine or mycophenolate mofetil did not independently affect the results; there was no difference in late rejection episodes. Moreover, renal function improved in the sirolimus group. Although the authors correctly poi
