Cardiac allograft vasculopathy prevention
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Cardiac allograft vasculopathy Microchapters |
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Differentiating Cardiac allograft vasculopathy from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Cardiac allograft vasculopathy prevention On the Web |
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American Roentgen Ray Society Images of Cardiac allograft vasculopathy prevention |
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Directions to Hospitals Treating Cardiac allograft vasculopathy |
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Risk calculators and risk factors for Cardiac allograft vasculopathy prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2] Raviteja Guddeti, M.B.B.S. [3]
Overview
Prevention
As the pathogenesis of CAV consists of both immunological and non-immunological insults, it has been suggested that preventative strategies should consist of control of risk factors for CAV and optimal immunosuppressive therapy. However, the best preventative strategy to delay development of CAV is yet to be determined.
Optimization of Immunosuppressive Therapy
Options for immunosuppressive therapy for prevention of CAV include [1]:
- Sirolimus (Rapamycin)
- Everolimus, a Rapamycin derivative
- Calcineurin inhibitors, such as
- Corticosteroids
- Mycophenolate mofetil
Everolimus and Sirolimus
- Act by inhibiting mTOR (mammalian target), thereby having anti-proliferative effects in response to allo-antigens.
- Associated with significantly reduced incidence of graft rejection.
- Serial IVUS studies to evaluate intimal proliferation demonstrated smaller increase in maximal intimal thickness and intimal index in patients taking everolimus. Similar results were found in trials that studied sirolimus.
- Side effect profile:
- Everolimus: increase in serum creatinine levels, hyperlipidemia, anemia, thrombocytopenia, peripheral edema, hypertension. However, opportunistic viral infections less often seen.
- Sirolimus: Similar to everolimus, however recent reports of impaired wound healing have been reported in renal transplant patients.
Calcineurin inhibitors
The use of calcineurin inhibitors i.e cyclosporin and tacrolimus have not been shown to lower the risk of developing CAV. This suggests that other immunological pathways may exists that play a role in the pathogenesis of CAV. Moreover, side effects from use of these drugs leads to a high incidence of not only chronic renal disease but also hypertension and hyperlipidemia which in turn may accelerate the process of CAV.
References
- ↑ Mehra MR (2006). "Contemporary concepts in prevention and treatment of cardiac allograft vasculopathy". Am J Transplant. 6 (6): 1248–56. doi:10.1111/j.1600-6143.2006.01314.x. PMID 16686747.