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(Circulation. 2004;110:3734-3740.)
© 2004 American Heart Association, Inc.

New Drugs and Technologies

Drug Therapy in the Heart Transplant Recipient

Part I: Cardiac Rejection and Immunosuppressive Drugs

JoAnn Lindenfeld, MD; Geraldine G. Miller, MD; Simon F. Shakar, MD; Ronald Zolty, MD; Brian D. Lowes, MD; Eugene E. Wolfel, MD; Luisa Mestroni, MD; Robert L. Page, II, PharmD; Jon Kobashigawa, MD

From the Division of Cardiology (J.L., S.F.S., R.Z., B.D.L., E.E.W., L.M.), Center for Women’s Health Research (J.L.), and Department of Clinical Pharmacy (R.L.P.), University of Colorado Health Sciences Center, Denver; Denver VA Medical Center (S.F.S.), Denver, Colo; Division of Infectious Diseases (G.G.M.), Vanderbilt University, Nashville, Tenn; and Division of Cardiology (J.K.), University of California, Los Angeles.

Correspondence to JoAnn Lindenfeld, MD, Division of Cardiology, University of Colorado Health Sciences Center, 4200 E Ninth Ave B-130, Denver, CO 80262. E-mail joann.lindenfeld@UCHSC.edu

Key Words: transplantation • immune system • rejection

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

	Introduction

 
Survival after heart transplantation has improved considerably over the past 20 years. Half of all patients now live >9 years, and 25% live 17 years.¹ Currently, 20 000 heart transplant recipients live in the United States.² Improved longevity means prolonged immunosuppression and the concomitant use of drugs to prevent or treat the long-term complications of immunosuppressive agents, such as infection, obesity, hypertension, hyperlipidemia, renal insufficiency, diabetes, osteoporosis, gout, and malignancies. In 1989, heart transplant recipients surviving 1 year were reported to be taking 16±6 drug doses per day (prescription and nonprescription).³ In 2001, heart transplant recipients surviving an average of 76 months were taking 7 prescription drugs (range, 2 to 14), along with a number of nonprescription drugs.⁴ Thus, despite prolonged survival, heart transplant recipients continue to take multiple medications. With the large number of heart transplant recipients in the community and the increasing number of immunosuppressive and nonimmunosuppressive drugs used by these patients, it is important that the general cardiologist understand these drugs, their side effects, and the very real potential for drug–drug interactions. These interactions may result in adverse events caused by supratherapeutic and subtherapeutic drug concentrations. In this series, we review mechanisms and types of rejection, immunosuppressive drugs commonly used in the heart transplant recipient, common medical problems after transplantation, and clinically significant drug–drug interactions.

	Rejection

 
A brief review of known immunologic mechanisms leading to graft rejection highlights the action of individual immunosuppressive drugs, as well as the rationale for combination therapy^5–8 (Figure). The rejection of . . . [Full Text of this Article]

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