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(Circulation. 2007;116:2666-2668.)
© 2007 American Heart Association, Inc.

Editorial

Sirolimus and Cardiac Transplantation

Is It the "Magic Bullet"?

Gilbert H. Mudge, Jr, MD

From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Gilbert H. Mudge, Jr, MD, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail gmudge@partners.org

Key Words: Editorials • sirolimus • transplantation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The Holy Grail of transplantation has been the hope to achieve lifelong tolerance to a transplanted organ without the need for nonspecific immunosuppression and its attendant side effects; the "magic bullet" is the means to achieve graft tolerance while avoiding complications. The biological and clinical complexities that have now emerged with solid organ transplantation have raised questions as to the relevance of a magic bullet. However, the article in this issue of Circulation by Raichlin and colleagues¹ suggests that we now need to revisit and perhaps redesign current long-term immunosuppressive strategies.

Article p 2726

	Have Long-Term Complications of Heart Transplantation Changed in the Past 20 Years?

 
The Registry of the International Society for Heart and Lung Transplantation presents a unique opportunity to understand the evolution of heart transplantation. It characterizes the care and complexities of >100 000 worldwide heart transplantations during the past 24 years.² Recent analysis suggests that the major improvements in survival have occurred within the first year of transplantation; this reflects the use of induction protocols with antithymocyte antibody or interleukin-2 antibody therapy and standardized initial immunosuppressant therapy. There has been a gradual improvement in the half-life of graft survival, but causes of long-term morbidity and mortality after cardiac transplantation have not changed in a decade.² By 8 years after transplantation, virtually all patients have hypertension, 40% have diabetes, and 40% have angiographic cardiac allograft vasculopathy (CAV); renal insufficiency is common, with long-term dialysis required in 10% of patients. The 3 leading causes of mortality and morbidity remain the same. CAV and unexplained graft failure (that may represent undetected . . . [Full Text of this Article]