Heart transplantation immunosuppressive therapy: Difference between revisions
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{{Heart transplantation}} | {{Heart transplantation}} | ||
'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]]; '''Associate Editor-In-Chief:''' {{CZ}} | '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]]; '''Associate Editor-In-Chief:''' {{CZ}}{{IF}} | ||
== | ==Overview== | ||
Post cardiac transplantation, medical therapy with [[Immunosuppressive therapy|immunosuppressive]] drugs is essential to prevent both [[Transplant rejection|acute and chronic rejection]]. [[Immunosuppressive therapy]] is given in two phases- Induction therapy and Maintenance therapy. The drugs used include different combinations of drugs like IL-2 Receptor antagonists, Anti-[[thymocyte]] [[antibodies]], [[calcineurin inhibitor]], anti-metabolite, [[glucocorticoids]], mammalian target of [[rapamycin]] [m-TOR] inhibitors, proliferation signal inhibitors and monoclonal Antibody OKT3. | |||
Post-transplantation [[immunosuppressive]] therapy | ==Medical Therapy== | ||
* Induction- Intense therapy for the first 2-3 months to prevent [[acute graft rejection]] | |||
* Maintenance- Throughout the life of the patient to combat both [[Acute (medicine)|acute]] and [[chronic rejection]]. <ref name="ChambersYusen2017">{{cite journal|last1=Chambers|first1=Daniel C.|last2=Yusen|first2=Roger D.|last3=Cherikh|first3=Wida S.|last4=Goldfarb|first4=Samuel B.|last5=Kucheryavaya|first5=Anna Y.|last6=Khusch|first6=Kiran|last7=Levvey|first7=Bronwyn J.|last8=Lund|first8=Lars H.|last9=Meiser|first9=Bruno|last10=Rossano|first10=Joseph W.|last11=Stehlik|first11=Josef|title=The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Lung And Heart-Lung Transplantation Report—2017; Focus Theme: Allograft ischemic time|journal=The Journal of Heart and Lung Transplantation|volume=36|issue=10|year=2017|pages=1047–1059|issn=10532498|doi=10.1016/j.healun.2017.07.016}}</ref> | *Immunosuppressive medical therapy is recommended in patients after undergoing cardiac transplantation. | ||
*Pharmacologic medical therapies or Post-transplantation [[immunosuppressive]] therapy includes two stages- | |||
** Induction- Intense therapy for the first 2-3 months to prevent [[acute graft rejection]] | |||
** Maintenance- Throughout the life of the patient to combat both [[Acute (medicine)|acute]] and [[chronic rejection]]. <ref name="ChambersYusen2017">{{cite journal|last1=Chambers|first1=Daniel C.|last2=Yusen|first2=Roger D.|last3=Cherikh|first3=Wida S.|last4=Goldfarb|first4=Samuel B.|last5=Kucheryavaya|first5=Anna Y.|last6=Khusch|first6=Kiran|last7=Levvey|first7=Bronwyn J.|last8=Lund|first8=Lars H.|last9=Meiser|first9=Bruno|last10=Rossano|first10=Joseph W.|last11=Stehlik|first11=Josef|title=The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Lung And Heart-Lung Transplantation Report—2017; Focus Theme: Allograft ischemic time|journal=The Journal of Heart and Lung Transplantation|volume=36|issue=10|year=2017|pages=1047–1059|issn=10532498|doi=10.1016/j.healun.2017.07.016}}</ref> | |||
Even though regimens vary from center to center and case to case, most regimens consist of 2-3 drugs, usually including- <ref>{{cite journal|doi=10.1016/j.healun.2017.07.019.}}</ref> <ref name="SöderlundRådegran2015">{{cite journal|last1=Söderlund|first1=Carl|last2=Rådegran|first2=Göran|title=Immunosuppressive therapies after heart transplantation — The balance between under- and over-immunosuppression|journal=Transplantation Reviews|volume=29|issue=3|year=2015|pages=181–189|issn=0955470X|doi=10.1016/j.trre.2015.02.005}}</ref> | Even though regimens vary from center to center and case to case, most regimens consist of 2-3 drugs, usually including- <ref>{{cite journal|doi=10.1016/j.healun.2017.07.019.}}</ref> <ref name="SöderlundRådegran2015">{{cite journal|last1=Söderlund|first1=Carl|last2=Rådegran|first2=Göran|title=Immunosuppressive therapies after heart transplantation — The balance between under- and over-immunosuppression|journal=Transplantation Reviews|volume=29|issue=3|year=2015|pages=181–189|issn=0955470X|doi=10.1016/j.trre.2015.02.005}}</ref> | ||
Latest revision as of 01:57, 8 July 2020
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [1]Ifrah Fatima, M.B.B.S[2]
Overview
Post cardiac transplantation, medical therapy with immunosuppressive drugs is essential to prevent both acute and chronic rejection. Immunosuppressive therapy is given in two phases- Induction therapy and Maintenance therapy. The drugs used include different combinations of drugs like IL-2 Receptor antagonists, Anti-thymocyte antibodies, calcineurin inhibitor, anti-metabolite, glucocorticoids, mammalian target of rapamycin [m-TOR] inhibitors, proliferation signal inhibitors and monoclonal Antibody OKT3.
Medical Therapy
- Immunosuppressive medical therapy is recommended in patients after undergoing cardiac transplantation.
- Pharmacologic medical therapies or Post-transplantation immunosuppressive therapy includes two stages-
- Induction- Intense therapy for the first 2-3 months to prevent acute graft rejection
- Maintenance- Throughout the life of the patient to combat both acute and chronic rejection. [1]
Even though regimens vary from center to center and case to case, most regimens consist of 2-3 drugs, usually including- [2] [3]
Induction Therapy
- IL-2 Receptor antagonists- Basiliximab [4]
- Anti-thymocyte antibodies- Associated with severe serum sickness like reaction [5]
Maintenance Therapy
- Calcineurin inhibitor- Tacrolimus or Cyclosporin; known to cause nephrotoxicity, hypertension, dyslipidemia. Gingival hyperplasia and hirsutism are associated with Cyclosporin alone.
- Anti-metabolite- Mycophenolate mofetil, Azathioprine
- Glucocorticoids- tapering dose
- Mammalian target of rapamycin [m-TOR] inhibitors and other strategies are aimed at minimizing the use of calcineurin inhibitors and corticosteroids.[6]
- Proliferation signal inhibitors (sirolimus and everolimus)- In the case of cardiac allograft vasculopathy (CAV) or renal insufficiency
- Monoclonal Antibody OKT3- Associated with an increase in the incidence of post-transplantation lymphoproliferative disorder[7]
References
- ↑ Chambers, Daniel C.; Yusen, Roger D.; Cherikh, Wida S.; Goldfarb, Samuel B.; Kucheryavaya, Anna Y.; Khusch, Kiran; Levvey, Bronwyn J.; Lund, Lars H.; Meiser, Bruno; Rossano, Joseph W.; Stehlik, Josef (2017). "The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Lung And Heart-Lung Transplantation Report—2017; Focus Theme: Allograft ischemic time". The Journal of Heart and Lung Transplantation. 36 (10): 1047–1059. doi:10.1016/j.healun.2017.07.016. ISSN 1053-2498.
- ↑ . doi:10.1016/j.healun.2017.07.019. Check
|doi=value (help). Missing or empty|title=(help) - ↑ Söderlund, Carl; Rådegran, Göran (2015). "Immunosuppressive therapies after heart transplantation — The balance between under- and over-immunosuppression". Transplantation Reviews. 29 (3): 181–189. doi:10.1016/j.trre.2015.02.005. ISSN 0955-470X.
- ↑ Penninga, Luit; Møller, Christian H; Gustafsson, Finn; Gluud, Christian; Steinbrüchel, Daniel A (2013). "Immunosuppressive T-cell antibody induction for heart transplant recipients". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008842.pub2. ISSN 1465-1858.
- ↑ Yamani MH, Taylor DO, Czerr J, Haire C, Kring R, Zhou L; et al. (2008). "Thymoglobulin induction and steroid avoidance in cardiac transplantation: results of a prospective, randomized, controlled study". Clin Transplant. 22 (1): 76–81. PMID 18251036.
- ↑ Herrero, María José; Megías, Juan Eduardo; Bosó, Virginia; Ruiz, Jesús; Rojas, Luis; Sánchez-Lázaro, Ignacio; Amenar, Luis; Hernández, Julio; Poveda, José Luis; Pastor, Amparo; Solé, Amparo; López-Andújar, Rafael; Aliño, Salvador F. (2016). "Pharmacogenetics of Immunosuppressants in Solid Organ Transplantation: Time to Implement in the Clinic". doi:10.5772/63071.
- ↑ Swinnen, Lode J.; Costanzo-Nordin, Maria R.; Fisher, Susan G.; O'Sullivan, E. Jeanne; Johnson, Maryl R.; Heroux, Alain L.; Dizikes, George J.; Pifarre, Roque; Fisher, Richard I. (1990). "Increased Incidence of Lymphoproliferative Disorder after Immunosuppression with the Monoclonal Antibody OKT3 in Cardiac-Transplant Recipients". New England Journal of Medicine. 323 (25): 1723–1728. doi:10.1056/NEJM199012203232502. ISSN 0028-4793.