What is new in heart transplantation
Authors:
L. Špinarová
Authors‘ workplace:
Lékařská fakulta MU a FN U sv. Anny
; I. interní kardioangiologická klinika
Published in:
Kardiol Rev Int Med 2008, 10(1): 14-17
Overview
After it was first performed in 1967, heart transplantation became a routine method of treatment of advanced heart failure in the 1980s. However, in spite of success achieved in transplantation follow up, there is a number of possibilities and options for research in improving the quality of life and survival of patients. New horizons of heart transplantation can be summarised as follows:
1. New approaches – combined heart – lung transplantation. 2. Research in new, more effective immunosuppressives with less adverse effects. We have seen mycophenolate replacing azathioprine in current therapy, tacrolimus and, prospectively, rapamycin or basiliximab as the drugs for resistant rejections. The use of rapamycin appears advantageous in patients with nephropathy as it allows for reducing or withdrawal of cyclosporin or tacrolimus in the treatment of graft vasculopathy. 3. Diagnosis of rejection events without the use of endomyocardial biopsy. Among non-invasive methods, research focuses on methods of echocardiography – tissue Doppler imaging, densitometry, contrast echocardiography, strain and strain rate, or the detection of specific hormonal agent levels, i.e. interleukin, brain natriuretic peptide or troponine T, or the detection of donor DNA in the blood of the receiver. 4. A more timely diagnosis of vasculopathy (intravascular ultrasound being one of the options in this case), and its pharmacological prevention in the first place. Statins are included for preventive therapy. Heart transplantation has become an established method for the treatment of severe heart failure in the last two decades. In spite of a number of issues, it prolongs and improves the quality of patients‘ lives. The future will show whether it can be replaced by different procedures.
Key words:
heart transplantation – immunosuppressives – rejection – vasculopathy – echocardiography
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Labels
Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
Cardiology Review
2008 Issue 1
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