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Use of Proliferation Signal Inhibitors in Cardiac Transplantation
Journal article   Open access   Peer reviewed

Use of Proliferation Signal Inhibitors in Cardiac Transplantation

Howard J. Eisen
Current transplantation reports, v 1(4)
2014
url
https://link.springer.com/content/pdf/10.1007%2Fs40472-014-0035-4.pdfView
Published, Version of Record (VoR) Open
url
https://doi.org/10.1007/s40472-014-0035-4View
Published, Version of Record (VoR) Open

Abstract

Immunology Medicine Medicine & Public Health Section Editor Surgery Thoracic Transplantation (J Kobashigawa Transplant Surgery
Cardiac transplantation remains the definitive and most highly successful therapy for patients with advanced heart failure who have failed all other therapies. Long-term survival is limited by cardiac allograft vasculopathy, the transplant coronary artery disease, and malignancy. Standard, traditional immunosuppressive agents such as calcineurin inhibitors, anti-proliferative agents, and corticosteroids do little to attenuate cardiac allograft vasculopathy, which, because of its diffuse nature, is usually not amenable to percutaneous or surgical revascularization approaches, and may potentiate the developments of malignancies after cardiac transplantation. Proliferation signal inhibitors block the mammalian target of rapamycin, a critical protein involved in cell proliferation, and inhibit lymphocyte and smooth muscle cell proliferation. This results in inhibition of the alloimmune response and acute cellular rejection, even in the setting of low calcineurin levels. More significantly, they have been shown in several clinical trials to attenuate the progression of cardiac allograft vasculopathy when compared to mycophenolate or azathioprine regimens.

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