Newer Immunosuppression and Strategies on the Horizon in Heart Transplantation

Purpose of Review: Balanced immunosuppressive therapy is the key to long-term survival after allograft transplantation. With a worldwide median recipient/graft survival of more than 11 years, heart transplantation is a highly successful treatment for selected patients with end-stage heart failure. However, current immunosuppressive regimens are associated with adverse effects. In the balance between acute rejection, cardiac allograft vasculopathy, infections and an increased risk of malignancy, there is room for improvement. The aim of this review article is to present an overview of immunosuppressive mechanisms and new immune therapy strategies in heart transplantation and to highlight emerging approaches in this field that may influence our immunosuppressive strategies in the future. Recent Findings: Calcineurin inhibitors have been the central drug class in post-transplant immunosuppressive regimens. New trials have explored alternative drugs, such as inhibitors of mechanistic target of rapamycin and belatacept. There is ongoing research on the development of strategies to induce long-term allograft tolerance. Summary: This review briefly introduces allograft rejection immunology, and sums up contemporary immunosuppressive strategies with emphasis on the development of calcineurin inhibitor-sparing regimens and the prospect of achieving long-term tolerance. © 2017, Springer International Publishing AG.