Targeting nonalloimmune-dependent pathways.

Abstract

Medical therapy to treat and prevent this major complication has progressed slowly. The early use of diltiazem, pravastatin, or photopheresis has had reported efficacy in slowing the development of TCAD but not in preventing its development. Current ongoing multicenter studies with mycophenolate mofetil, angiopeptin, and other agents may hold promise for the future. It is clear that whatever intervention is applied, it must be started at the time of transplantation, as the cascade of events of TCAD begins at the time of surgery. Revascularization procedures, including angioplasty and CABS, have proven to be palliative and not applicable to all patients with TCAD. Currently, retransplantation remains the only viable treatment for patients with severe transplant vasculopathy. For patients undergoing retransplantation for severe TCAD, survival and the development of TCAD in the second donor heart appear acceptable compared to outcomes for patients undergoing primary heart transplantation. The ethical dilemma surrounding heart retransplantation, however, is considerable because of the scarcity of donor organs.