Long-term care of the heart transplant recipient

This article will review the long-term care of the heart transplant recipient, focusing on the major causes of mortality and morbidity after transplantation.

The major causes of mortality include rejection, infection, malignancy, and transplant coronary artery disease. The major causes of morbidity include renal dysfunction, hypertension, diabetes, dyslipidemia, gout, and osteoporosis. Strategies for prevention and management of these complications include advances in noninvasive monitoring assays. These assays, including the AlloMap gene expression profile for monitoring of rejection and the Cylex immune monitoring score for monitoring of over-immunosuppression, will allow better assessment of rejection and the level of immune response.

Newer advances in rejection surveillance and immune monitoring will allow clinicians to tailor current therapies to the needs of individual heart transplant recipients to maximize benefit and minimize toxicity.