Heart transplantation immunosuppressive therapy: Difference between revisions
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*'''Calcineurin inhibitor'''- Tacrolimus or Cyclosporin | *'''Calcineurin inhibitor'''- Tacrolimus or Cyclosporin | ||
* '''Anti-metabolite'''- Mycophenolate mofetil, Azathioprine | *'''Anti-metabolite'''- Mycophenolate mofetil, Azathioprine | ||
*''' Glucocorticoids'''- tapering dose | *''' Glucocorticoids'''- tapering dose | ||
* Mammalian target of rapamycin [m-TOR] inhibitors and other strategies are aimed at minimizing the use of calcineurin inhibitors and corticosteroids. | *''' Mammalian target of rapamycin [m-TOR] inhibitors''' and other strategies are aimed at minimizing the use of calcineurin inhibitors and corticosteroids.<ref name="HerreroMegías2016">{{cite journal|last1=Herrero|first1=María José|last2=Megías|first2=Juan Eduardo|last3=Bosó|first3=Virginia|last4=Ruiz|first4=Jesús|last5=Rojas|first5=Luis|last6=Sánchez-Lázaro|first6=Ignacio|last7=Amenar|first7=Luis|last8=Hernández|first8=Julio|last9=Poveda|first9=José Luis|last10=Pastor|first10=Amparo|last11=Solé|first11=Amparo|last12=López-Andújar|first12=Rafael|last13=Aliño|first13=Salvador F.|title=Pharmacogenetics of Immunosuppressants in Solid Organ Transplantation: Time to Implement in the Clinic|year=2016|doi=10.5772/63071}}</ref> | ||
* '''Proliferation signal inhibitors (sirolimus and everolimus)'''- In case of cardiac allograft vasculopathy (CAV) or renal insufficiency | |||
* '''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<ref name="SwinnenCostanzo-Nordin1990">{{cite journal|last1=Swinnen|first1=Lode J.|last2=Costanzo-Nordin|first2=Maria R.|last3=Fisher|first3=Susan G.|last4=O'Sullivan|first4=E. Jeanne|last5=Johnson|first5=Maryl R.|last6=Heroux|first6=Alain L.|last7=Dizikes|first7=George J.|last8=Pifarre|first8=Roque|last9=Fisher|first9=Richard I.|title=Increased Incidence of Lymphoproliferative Disorder after Immunosuppression with the Monoclonal Antibody OKT3 in Cardiac-Transplant Recipients|journal=New England Journal of Medicine|volume=323|issue=25|year=1990|pages=1723–1728|issn=0028-4793|doi=10.1056/NEJM199012203232502}}</ref> | |||
==References== | ==References== | ||
Revision as of 13:10, 7 June 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]
Immunosuppressive Therapy
Post-transplantation immunosuppressive therapy consists of two stages- Induction and Maintenance. [1]
Even though regimens vary from center to center and case to case, most regimens consist of 2-3 drugs, usually including- [2] [3]
- Calcineurin inhibitor- Tacrolimus or Cyclosporin
- 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.[4]
- 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[5]
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.
- ↑ 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.