Current opinion in organ transplantation
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Mechanical circulatory support is expanding the treatment of advanced heart failure. The number of heart transplantations performed worldwide remains fairly static, and medical therapy alone for end stage heart failure continues to have dismal results. This article presents the authors' opinion as to the current status, challenges, and future course of the field of mechanical circulatory support. ⋯ Mechanical circulatory support holds great promise in the treatment of advanced heart failure. It is critical to change the perception of both the clinician and the patient toward the prognosis of end stage heart failure. The prospect of achieving long-term myocardial recovery using mechanical support as a platform for other strategies is exciting and requires intensive future investigation.
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Curr Opin Organ Transplant · Oct 2008
ReviewEvidence for immunosuppression in lung transplantation.
Historically, most lung transplant recipients have received triple-drug maintenance immunosuppression consisting of a calcineurin inhibitor, azathioprine, and prednisolone. The introduction of mycophenolate mofetil, mammalian target of rapamycin (mTOR) inhibitors, and antibody-based induction therapy has broadened immunosuppressive options. The purpose of this review is to summarize the evidence for immunosuppressive regimens in the prevention and treatment of lung allograft rejection. ⋯ Combination therapy with a calcineurin inhibitor, antimetabolite, and a corticosteroid derivative remains the backbone of lung transplant immunosuppression. Induction therapy (in whatever form) may reduce acute rejection, but does not lower the incidence of chronic rejection or improve survival. New strategies utilizing mTOR inhibitors may herald a more promising era.