Immunosuppressive therapies after heart transplantation: best, better, andbeyond

Despite the significant advances in transplantation immunology and immunosu ppressive therapies over the past 30 years, current immunosuppressive regim ens are still inadequate in the majority of cardiac transplant recipients. Although short-and long-term survival rates have improved significantly, on ly 50% will survive 10 years and very few will survive 20 years. Complicati ons of overimmunosuppression and underimmunosuppression account for the maj ority of these deaths. Only true "immunologic" tolerance can provide the ou tcome we pursue, namely, prolonged allograft function and otherwise normal immune function without chronic immunosuppressive therapy and its risks. Un til a successful tolerance-inducing protocol is developed, we must use the current and upcoming immunosuppressive agents and techniques. (C) 2000 Lipp incott Williams & Wilkins, Inc.