New Immunosuppressive Drugs in Cardio-Thoracic TransplantationF. Caes MD
Centrum voor Cardiochirurgie, UZ Gent
Current immunosuppressive regimens in cardio-thoracic transplantation (Tx) combine calcineurin inhibitors (cyclosporin, tacrolimus), antimitotic agents (azathioprine, mycophenolate mofetil [MMF]) and steroids, with or without induction therapy. With the discovery of new agents, therapeutic options and strategies have evolved and show promising or convincing clinical results in heart and lung Tx. Cyclosporin (Neoral°) C2 monitoring may optimize immunosuppression and decrease cyclosporin toxicity. MMF in substitution for azathioprine reduces significantly mortality and rejection after cardiac Tx, but the superiority of MMF after lung Tx has yet to be proven. Chimeric anti-IL2-receptor monoclonal antibodies (Basiliximab, Daclizumab) block the interleukin-2 receptor on the surface of activated T cells and provide efficient induction therapy with simple dosing regimen and minimal side effects. Proliferation signal inhibitors (sirolimus, everolimus) compared to azathioprine demonstrate a lower incidence of acute rejection, allograft vasculopathy and CMV infections, but an increase in serum lipids in heart Tx recipients. Statins result not only in cholesterol lowering after heart Tx, but also less severe rejection, reduced allograft vasculopathy and better survival.
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