Immunosuppressive Management of the Heart Transplant Recipient

Heart transplantation has become an established therapeutic option for selected patients with end-stage heart disease. However, until the advent of effective immunosuppression, allograft rejection has been the main challenge limiting survival in the early days after transplantation. Therapeutic success in cardiac transplantation evolved particularly with the introduction of the calcineurin inhibitors (CNIs), cyclosporin, and Tacrolimus (TAC) [1, 2]. Not only infection but also rejection rates declined sharply and contributed to the improvement in survival noted. Although rejection rates continue to decline, the risk of rejection remains significant particularly in the early period following transplantation, necessitating routine surveillance for both acute cellular and antibody-mediated rejection (AMR).