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Published on: November 2, 2019
Medication management of cardiac allograft vasculopathy after heart transplantation
Ian B Hollis1, Brent N Reed2, Michael P Moranville3
1Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, North Carolina.
Insights
Effective medication management is crucial for preventing cardiac allograft vasculopathy (CAV) after heart transplantation (HT). Sirolimus is the only medication shown to halt the progression of existing CAV.
Area of Science:
- Cardiology
- Immunology
- Pharmacology
Background:
- Cardiac allograft vasculopathy (CAV) is a frequent complication after heart transplantation (HT), significantly reducing graft survival.
- Optimal medical management is key for CAV prevention, while effective medication strategies are vital for managing established disease.
Purpose of the Study:
- To review the literature on medication management for preventing and treating cardiac allograft vasculopathy (CAV) in heart transplant recipients.
Main Methods:
- A comprehensive literature search of the MEDLINE database was performed.
- Included studies were in English, involved human subjects aged 18 years or older, and utilized non-investigational medications.
Main Results:
- Immunosuppressants (mycophenolate, tacrolimus, sirolimus, everolimus) and cardiovascular drugs (statins, gemfibrozil, CCBs, ACE inhibitors) can prevent CAV.
- Cytomegalovirus prophylaxis and antioxidants also aid in CAV prevention.
- Antiplatelet agents and glycemic control were ineffective for CAV prevention.
- Sirolimus uniquely demonstrated the ability to arrest the progression of existing CAV.
Conclusions:
- Several immunosuppressive and cardiovascular medications, alongside specific prophylactic and antioxidant therapies, are effective in preventing CAV.
- Sirolimus stands out for its potential to halt the progression of established CAV, highlighting its importance in long-term heart transplant management.
Abstract:
Cardiac allograft vasculopathy (CAV) is a common complication following heart transplantation (HT), resulting in diminished graft survival. The preferred strategy for preventing CAV is optimal medical management; however, for patients who develop CAV, delaying disease progression through effective medication management is equally important. A review of the literature regarding medication management of CAV was conducted via a search of the MEDLINE database. Studies were included if they were published in English, conducted in humans ≥ 18 years of age or older, and used noninvestigational medications. Immunosuppressive medications such as the antiproliferative mycophenolate, the calcineurin inhibitor tacrolimus, and the proliferation signal inhibitors sirolimus and everolimus have been shown to prevent the development of CAV. Certain cardiovascular medications, such as HMG-CoA reductase inhibitors (statins), gemfibrozil, calcium channel blockers, and angiotensin-converting enzyme inhibitors, have also demonstrated efficacy in preventing this disease process. Prevention of CAV has also been observed with prophylaxis against cytomegalovirus infection and antioxidant medications. Despite being commonly used in HT patients, neither antiplatelet agents nor glycemic control have proved effective at preventing CAV. Only sirolimus has been shown to arrest the progress of existing CAV.
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