Management of the patient after heart transplant
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Cardiac transplantation is a highly effective therapy for selected patients with end-stage cardiac disease. The management of the patient after heart transplant involves three main strategies: optimization of immunosuppressive therapy, prevention of complications resulting from the transplant or the immunosuppressive agents, and treatment of those complications when they arise. For most patients, optimal current immunosuppression in the first year after transplantation consists of combination therapy with a calcineurin inhibitor (eg, cyclosporine or tacrolimus), corticosteroids, and an antimetabolite agent (eg, azathioprine or mycophenolate mofetil). Ideally, the corticosteroid is weaned and discontinued 1 to 2 years following transplantation and the patient is managed chronically with a two-drug immunosuppressive regimen. The major complications that occur following cardiac transplantation include infection, hypertension, diabetes, dyslipidemia, osteoporosis, graft coronary disease, renal insufficiency, and malignancy. Preventive efforts focused on infection, osteoporosis, renal insufficiency, and malignancy include minimization of immunosuppression. Once established, treatment of any of the above conditions generally relies on standard pharmacologic therapies; however, an understanding of potential drug interactions is critical. In addition, although standard nonpharmacologic therapies may be used to treat several of these conditions, one must be cognizant of special issues related to the post-transplant state.
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References and Recommended Reading
- 1.Taylor DO, Edwards LB, Mohacsi PJ, et al.: The Registry of the International Society for Heart and Lung Transplantation: Twentieth Official Adult Heart Transplant Report-2003. J Heart Lung Transplant 2003, 22:616–624. The most recent report from the International Society for Heart and Lung Transplantation registry on adult heart transplant. Reviews trends in volume, patient and donor characteristics, and outcomes, including the relative importance of various post-transplant medical conditions.PubMedCrossRefGoogle Scholar
- 2.International Society for Heart and Lung Transplant. http:/www.ishlt.org/registries/. Accessed June 1, 2004.Google Scholar
- 3.Brann WM, Bennett LE, Keck BM, Hosenpud JD: Morbidity, functional status, and immunosuppressive therapy after heart transplantation: an analysis of the Joint International Society for Heart and Lung Transplantation/United Network for Organ Sharing Thoracic Registry. J Heart Lung Transplant 1998, 17:374–382.PubMedGoogle Scholar
- 22.Keay S: Cardiac transplantation: pre-transplant infectious diseases evaluation and post-transplant prophylaxis. Curr Infect Dis Rep 2002, 4:285–292. An exhaustive review of current understanding and practice patterns for the management of the infectious complications of cardiac transplantation and immunosuppression.PubMedCrossRefGoogle Scholar
- 30.Fatemeh A, Jackson CH, Parameshwar J, et al.: Risk factors for the development and progression of dyslipidemia after heart transplantation. Transplantation 2003, 73:1258–1264.Google Scholar