New advances in antirejection therapy

The prevention and treatment of rejection have been the major focus of clinical and research studies since the inception of heart transplantation. Recent improvement in survival after transplant has been in large part due to continued advancement in antirejection therapies.

The combination of steroids/cyclosporine/azathioprine has been widely used since the early 1980s. The last decade has seen the increasing use of the drugs mycophenolate mofetil and tacrolimus. Newer agents such as target of rapamycin protein inhibitors and anti-interleukin-2 inhibitors have come under intense research recently, and may play a significant role in heart transplantation. Further study is required for agents such as rituximab. With the recent introduction of a new grading of cardiac allograft rejection, controversy remains over when rejection should be treated and which agents should be used.

Use of newer proven antirejection drugs has reduced rejection and improved survival after heart transplantation. Rejection and side effects from these drugs are still major problems, however; therefore continued research in this area is required.