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Immunosuppressive therapies after heart transplantation - The balance between under- and over-immunosuppression.

Söderlund, Carl LU and Rådegran, Göran LU (2015) In Transplantation Reviews 29(3). p.181-189
Abstract
Since the first heart transplantation (HT) in 1967, survival has steadily improved. Issues related to over- and under-immunosuppression are, however, still common following HT. Whereas under-immunosuppression may result in rejection, over-immunosuppression may render other medical problems, including infections, malignancies and chronic kidney disease (CKD). As such complications constitute major limiting factors for long-term survival following HT, identifying improved diagnostic and preventive methods has been the focus of many studies. Notably, research on antibody-mediated rejection (AMR) and cardiac allograft vasculopathy (CAV) has recently led to the development of nomenclatures that may aid in their diagnosis and treatment.... (More)
Since the first heart transplantation (HT) in 1967, survival has steadily improved. Issues related to over- and under-immunosuppression are, however, still common following HT. Whereas under-immunosuppression may result in rejection, over-immunosuppression may render other medical problems, including infections, malignancies and chronic kidney disease (CKD). As such complications constitute major limiting factors for long-term survival following HT, identifying improved diagnostic and preventive methods has been the focus of many studies. Notably, research on antibody-mediated rejection (AMR) and cardiac allograft vasculopathy (CAV) has recently led to the development of nomenclatures that may aid in their diagnosis and treatment. Moreover, novel immunosuppressants (such as mammalian target of rapamycin [m-TOR] inhibitors) and strategies aimed at minimizing the use of calcineurin inhibitors (CNIs) and corticosteroids (CSs), have provided alternatives to the traditional combination maintenance immunosuppressive therapy of CSs, cyclosporine (CSA) or tacrolimus (TAC), and azathioprine (AZA) or mycophenolate mofetil (MMF). Research within this field of medicine is not only extensive, but also in constant progress. The purpose of the present review was therefore to summarize some major points regarding immunosuppressive therapies after HT and the balance between under- and over-immunosuppression. Transplant immunology, rejection, common medical problems related to over-immunosuppression, as well as induction and maintenance immunosuppressive drugs and therapies, are addressed. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Transplantation Reviews
volume
29
issue
3
pages
181 - 189
publisher
Elsevier
external identifiers
  • pmid:25812489
  • wos:000356635000012
  • scopus:84952874947
ISSN
1557-9816
DOI
10.1016/j.trre.2015.02.005
language
English
LU publication?
yes
id
9a0a76cf-d511-4ea9-836b-6483e21809ab (old id 5257605)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/25812489?dopt=Abstract
date added to LUP
2015-04-04 17:30:30
date last changed
2017-11-12 03:00:59
@article{9a0a76cf-d511-4ea9-836b-6483e21809ab,
  abstract     = {Since the first heart transplantation (HT) in 1967, survival has steadily improved. Issues related to over- and under-immunosuppression are, however, still common following HT. Whereas under-immunosuppression may result in rejection, over-immunosuppression may render other medical problems, including infections, malignancies and chronic kidney disease (CKD). As such complications constitute major limiting factors for long-term survival following HT, identifying improved diagnostic and preventive methods has been the focus of many studies. Notably, research on antibody-mediated rejection (AMR) and cardiac allograft vasculopathy (CAV) has recently led to the development of nomenclatures that may aid in their diagnosis and treatment. Moreover, novel immunosuppressants (such as mammalian target of rapamycin [m-TOR] inhibitors) and strategies aimed at minimizing the use of calcineurin inhibitors (CNIs) and corticosteroids (CSs), have provided alternatives to the traditional combination maintenance immunosuppressive therapy of CSs, cyclosporine (CSA) or tacrolimus (TAC), and azathioprine (AZA) or mycophenolate mofetil (MMF). Research within this field of medicine is not only extensive, but also in constant progress. The purpose of the present review was therefore to summarize some major points regarding immunosuppressive therapies after HT and the balance between under- and over-immunosuppression. Transplant immunology, rejection, common medical problems related to over-immunosuppression, as well as induction and maintenance immunosuppressive drugs and therapies, are addressed.},
  author       = {Söderlund, Carl and Rådegran, Göran},
  issn         = {1557-9816},
  language     = {eng},
  number       = {3},
  pages        = {181--189},
  publisher    = {Elsevier},
  series       = {Transplantation Reviews},
  title        = {Immunosuppressive therapies after heart transplantation - The balance between under- and over-immunosuppression.},
  url          = {http://dx.doi.org/10.1016/j.trre.2015.02.005},
  volume       = {29},
  year         = {2015},
}