Heart Transplant Program, Bologna Academic Hospital, Policlinico S. Orsola-Malpighi, Building 25, Via Massarenti, 9, 40138, Bologna, Italy.
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Curr Cardiol Rep. 2018 Jul 10;20(9):73. doi: 10.1007/s11886-018-1018-3.
Despite the improvement in medical therapy for heart failure and the advancements in mechanical circulatory support, heart transplantation (HT) still remains the best therapeutic option to improve survival and quality of life in patients with advanced heart failure. Nevertheless, HT recipients are exposed to the risk of several potential complications that may impair their outcomes. In this article, we aim to provide a practical and scholarly framework for clinicians approaching heart transplant medicine, as well as a concise update for the experienced readers on the most relevant post-HT complications.
While recognizing that most of the treatments herein discussed are based more on experience than on solid scientific evidence, significant step forward has been made in particular in the recognition and management of primary graft dysfunction, antibody-mediated rejection, and renal dysfunction. Complications after HT may vary according to the time from surgery and can be related to graft function and pathology or to diseases and dysfunctions occurring in other organs or systems, mainly as side effects of immunosuppressive drugs and progression of pre-existing conditions. Future research needs to focus on improving precision diagnostics of causes of graft dysfunction and on reaching an optimal and customized balance between efficacy and toxicities of immunosuppressive strategies.
尽管心力衰竭的医学治疗有所改善，机械循环支持也有所进步，但心脏移植（HT）仍然是改善晚期心力衰竭患者生存和生活质量的最佳治疗选择。然而，HT 受者面临着多种潜在并发症的风险，这些并发症可能会影响他们的预后。本文旨在为临床医生提供一个实用的、学术性的心脏移植医学方法框架，并为有经验的读者提供有关 HT 后最相关并发症的简明更新。
尽管我们认识到这里讨论的大多数治疗方法更多地基于经验而不是确凿的科学证据，但在原发性移植物功能障碍、抗体介导的排斥反应和肾功能障碍的识别和管理方面已经取得了重大进展。HT 后的并发症可能因手术时间而异，可与移植物功能和病理学有关，也可与其他器官或系统发生的疾病和功能障碍有关，主要是免疫抑制药物的副作用和原有疾病的进展。未来的研究需要集中于改善移植物功能障碍原因的精准诊断，并在免疫抑制策略的疗效和毒性之间达到最佳和定制的平衡。
