Recent advances in the role of mammalian target of rapamycin inhibitors on cardiac allograft vasculopathy

Abstract

Cardiac allograft vasculopathy (CAV) is a progressive fibroproliferative disease, which contributes to significant morbidity and mortality during long-term follow-up after heart transplantation. Mammalian target of rapamycin (mTOR) inhibitors have favorable effects on endothelial function and reduce intimal proliferation, and their early use after transplantation has been associated with a reduction in the risk of development and progression of CAV. However, there are conflicting reports on the efficacy of these agents in treating established CAV. Most of the data until recently have been based on short-term follow-up, and CAV was assessed by changes in intravascular ultrasound. In this study, we review the mechanism of action of mTOR inhibitors and their protective role in CAV and summarize some of the recent literature, which include long-term follow-up using this class of medications.

Keywords: heart (allograft) function/dysfunction; immunosuppression; mechanistic target of rapamycin; rejection: vascular; vasculopathy.