Division of Cardiology, Temple University School of Medicine, Philadelphia, PA, USA.
Handb Exp Pharmacol. 2022;272:337-348. doi: 10.1007/164_2021_547.
The use of Immunosuppression has led to the tremendous improvement in graft survival. However, immunosuppressants have been found to cause a variety of metabolic derangements including but not limited to: insulin resistance and diabetes, hyperlipidemia, hypertension, and weight gain after transplantation. This combination of metabolic risk factors may be associated with increased cardiovascular disease (Grundy et al., Circulation 112(17):2735, 2005). In addition many transplant recipients may have many of these risk factors pre-transplant that are exacerbated by immunosuppression. These facts emphasize the need for rigorous follow-up and management of these risk factors post-transplant.The most common immune suppressant regimens may include different combinations of these agents: Corticosteroids, Calcineurin inhibitors (CNIs), Mammalian Target of Rapamycin (mTOR) Inhibitors, Antimetabolite.
免疫抑制的应用显著提高了移植物的存活率。然而，免疫抑制剂会引起多种代谢紊乱，包括但不限于：胰岛素抵抗和糖尿病、血脂异常、高血压以及移植后体重增加。这种代谢危险因素的组合可能与心血管疾病的风险增加有关（Grundy 等人，Circulation 112(17):2735, 2005）。此外，许多移植受者在移植前可能已经存在多种风险因素，而免疫抑制会使这些因素恶化。这些事实强调了需要在移植后对这些危险因素进行严格的随访和管理。最常见的免疫抑制剂方案可能包括这些药物的不同组合：皮质类固醇、钙调神经磷酸酶抑制剂 (CNI)、雷帕霉素靶蛋白 (mTOR) 抑制剂、抗代谢物。
