New options decrease transplant rejection odds
New options decrease transplant rejection odds
Medications offer alternative to cyclosporine
Clinicians treating heart transplant rejection have little choice but to subject their patients to drugs known to produce a variety of side effects, some of which are potentially fatal.
In the near future, however, that may well cease to be a problem. The new drugs being studied reportedly not only prevent transplant rejection, but eliminate potential side effects as well.
Avoiding dangerous side effects
Among them are two new intravenous drugs used acutely following transplant in lieu of cyclosporine. Cyclosporine can cause numerous side effects, including kidney failure.
With the advent of the new drugs, "You don’t even have to use cyclosporine for the first few weeks," says Reynolds Delgado, MD, assistant medical director, department of cardiopulmonary transplantation, St. Luke’s Episcopal Hospital/Texas Heart Institution in Houston.
Also being considered are two new pill form medications that can either be used instead of or in combination with cyclosporine. The pills’ primary advantage is that "it allows us to cut the (cyclosporine) dosage way down," Delgado says. Rapaycin, one of the medications in consideration, is successful in kidney transplants and is showing promise with heart transplantation as well, he adds.
Largely as a result of improved medications, the incidence of heart transplant rejection has decreased considerably in recent years. "We’re doing a lot better with coronary artery disease because we are using staten drugs [to lower cholesterol] after all the transplants," says Delgado.
Thousands could be helped by advances
In spite of the advances, of the approximately 2,000 heart transplants performed every year in the United States alone, "it is estimated that a number in excess of 40,000 could benefit from them," Delgado says. "We need to find a way to help these people — and that is where the new artificial heart devices we are working on come in."
For treatment of heart transplant rejection, "There’s also an increased interest in percutaneous myocardial revascularization, which basically is a laser that makes small holes in the heart to stimulate angiogenesis," according to Charles Inman Wilmer, MD, director of angioplasty and cardiac disease specialist and director of data management at the Fuqua Heart Center of Piedmont Hospital in Atlanta.
Also being studied are various revolutionary devices such as a new battery-powered pump that does not require a wire connection to the patient and an enhanced extra corporeal counterpulsation for inoperable patients with angina who otherwise would require transplantation, says Wilmer.
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