A Comprehensive and Contemporary Review on Immunosuppression Therapy for Heart Transplantation

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art_GOLDRAICH_A_Comprehensive_and_Contemporary_Review_on_Immunosuppression_Therapy_2020.PDF (5.23 MB)
Citações na Scopus
12
Tipo de produção
article
Data de publicação
2020
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
BENTHAM SCIENCE PUBL LTD
Autores
GOLDRAICH, Livia A.
LEITAO, Santiago A. Tobar
SCOLARI, Fernando L.
BONATTO, Marcely G.
MUNYAL, Dipika
HARRISON, Jennifer
RIBEIRO, Rafaela V. P.
PIARDI, Diogo
Citação
CURRENT PHARMACEUTICAL DESIGN, v.26, n.28, p.3351-3384, 2020
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Heart transplantation is the standard of therapy for patients with end-stage heart disease. Since the first human-to-human heart transplantation, performed in 1967, advances in organ donation, surgical techniques, organ preservation, perioperative care, immunologic risk assessment, immunosuppression agents, monitoring of graft function and surveillance of long-term complications have drastically increased recipient survival. However, there are yet many challenges in the modern era of heart transplantation in which immunosuppression may play a key role in further advances in the field. A fine-tuning of immune modulation to prevent graft rejection while avoiding side effects from over immunosuppression has been the vital goal of basic and clinical research. Individualization of drug choices and strategies, taking into account the recipient's clinical characteristics, underlying heart failure diagnosis, immunologic risk and comorbidities seem to be the ideal approaches to improve post-transplant morbidity and survival while preventing both rejection and complications of immunosuppression. The aim of the present review is to provide a practical, comprehensive overview of contemporary immunosuppression in heart transplantation. Clinical evidence for immunosuppressive drugs is reviewed and practical approaches are provided. Cardiac allograft rejection classification and up-to-date management are summarized. Expanding therapies, such as photophoresis, are outlined. Drug-to-drug interactions of immunosuppressive agents focused on cardiovascular medications are summarized. Special situations involving heart transplantation such as sarcoidosis, Chagas diseases and pediatric immunosuppression are also reviewed. The evolution of phamacogenomics to individualize immunosuppressive therapy is described. Finally, future perspectives in the field of immunosuppression in heart transplantation are highlighted.
Palavras-chave
Heart transplantation, immunosuppression, clinical management, rejection, drug interactions, pharmacogenomics
URI
https://observatorio.fm.usp.br/handle/OPI/38045
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Coleções
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - ODS/03