Hullin Roger
Service de Cardiologie, Département de Médecine Interne, Centre Hospitalier Universitaire (CHUV), Faculté Biologie et Médecine d'UNIL, Lausanne, Switzerland.
Swiss Med Wkly. 2014 Aug 7;144:w13977. doi: 10.4414/smw.2014.13977. eCollection 2014.
The field of heart transplantation has seen substantial progress in the last 40 years. The breakthroughs in long-term survival were followed by a period of stagnation in the last decade. This review summarises current recommendations for the identification of candidates for heart transplantation and their immunological and non-immunological postoperative follow-up.
The progress made in the treatment of patients with advanced heart failure has considerably changed the profile of candidates for heart transplantation. Patients are older, and the load of co-morbidities is more important requiring careful evaluation for candidacy. Long-standing research in the field of immunosuppression made available various drugs, which decrease the risk of acute allograft rejection and prolong survival after heart transplantation. Powerful new molecules are entering early phase clinical studies, suggesting further improvement in the near future. As a consequence, treatment of non-immunological co-morbidity after heart transplantation will gain in importance, however, the base of evidence guiding current recommendations is poor.
The substantial progress in heart failure treatment and immunosuppression after heart transplantation has changed the profile of heart transplant recipients. The arrival of new molecules will provide additional alternatives for immunosuppressive treatment while studies have to address non-immunological treatment in order to improve long-term survival after heart transplantation.
在过去40年里，心脏移植领域取得了显著进展。长期生存率取得突破之后，在过去十年出现了一段停滞期。本综述总结了目前关于心脏移植候选者识别及其免疫和非免疫术后随访的建议。
晚期心力衰竭患者治疗方面取得的进展极大地改变了心脏移植候选者的情况。患者年龄更大，合并症负担更重，需要对候选资格进行仔细评估。免疫抑制领域的长期研究提供了多种药物，这些药物降低了急性移植物排斥反应的风险，并延长了心脏移植后的生存期。强大的新分子正进入早期临床研究，表明在不久的将来会有进一步改善。因此，心脏移植后非免疫合并症的治疗将变得更加重要，然而，指导当前建议的证据基础薄弱。
心力衰竭治疗和心脏移植后免疫抑制方面的显著进展改变了心脏移植受者的情况。新分子的出现将为免疫抑制治疗提供更多选择，同时研究必须关注非免疫治疗，以提高心脏移植后的长期生存率。
