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(Circulation. 2005;111:113-117.)
© 2005 American Heart Association, Inc.

New Drugs and Technologies

Drug Therapy in the Heart Transplant Recipient

Part III: Common Medical Problems

JoAnn Lindenfeld, MD; Robert L. Page, II, PharmD; Ronald Zolty, MD; Simon F. Shakar, MD; Marilyn Levi, MD; Brian Lowes, MD; Eugene E. Wolfel, MD; Geraldine G. Miller, MD

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

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

Received March 16, 2004; revision received July 23, 2004; accepted September 30, 2004.

Key Words: transplantation • drugs • immunology • rejection

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

	Introduction

 
Continued improvement in the long-term survival of heart transplant recipients has resulted in a population of patients with prolonged exposure to immunosuppressive drugs.¹ This exposure, coupled with the increasing age of recipients, has resulted in an impressive prevalence of comorbidities in these patients. Indeed, by 5 years after transplantation, 95% of recipients have hypertension, 81% have hyperlipidemia, and 32% have diabetes.¹ In addition, 25% to 50% have coronary allograft vasculopathy (CAV), and up to 33% have chronic renal insufficiency.^2–5 As more drugs are developed to both prevent and treat these problems and common infectious complications after transplantation, it is likely that the heart transplant recipient will be taking an increasing number of drugs. Because standard immunosuppressive drugs have a high potential for drug–drug interactions, the heart transplant recipient is subject to an enormous risk for drug–drug interactions. In this article, we briefly review common medical problems in heart transplant recipients that are routinely addressed with drug therapy. In Part IV of this series, we provide specific details of known important and common drug–drug interactions, along with recommendations for management.

	Coronary Allograft Vasculopathy

 
CAV was described in Part I of this series. The mechanism is incompletely understood but is likely a consequence of both immunologic and nonimmunologic factors.³ CAV is present in 42% of heart transplant recipients at 5 years.³ After the first posttransplantation year, CAV is responsible for 20% of all deaths.^1,6 CAV often involves the coronary arteries in a diffuse fashion, making percutaneous coronary interventions or bypass surgery less effective in many . . . [Full Text of this Article]

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