Drug management of the cardiac transplant patient

Abstract

Drug or pharmacologic management of patients with cardiac allografts is an area of clinical cardiology that is quite different from most pharmacological management involved in caring for patients with cardiac disease. In transplant patients one is dealing with a heart that is not stunned, ischemic, infarcted, hypertrophied, dilated, or in any way weak or structurally abnormal. The patient has a perfectly healthy heart, usually chronologically younger than the patient, the only flaw of which is its antigenic dissimilarity from tissue of the patient. This dissimilarity, of course, leads to the need to suppress the normal immune response and make the patient at least relatively immunologically tolerant of his or her solid organ allograft. Problems inherent in the induction and maintenance of immune tolerance in cardiac allograft patients are no different than those encountered in the more widely practiced field of renal transplantation. The major obvious difference is that of the more disastrous consequence of graft "loss" in cardiac transplant recipients since no cardiac equivalent of chronic hemodialysis exists to be resorted to. Thus, immunosuppressive regimens used in cardiac transplant programs tend to err (if they err) on the side of heavier suppression and accept the consequences of this choice.