APPROACH TO IMMUNOSUPPRESSION IN PATIENTS AFTER HEART TRANSPLANT: UPDATES

Abstract

INTRODUCTION: Patients with advanced heart failure (HF) refractory to optimized clinical and surgical interventions commonly undergo heart transplantation to improve quality of life, survival, and graft functionality. Thus, aiming to reduce rejection episodes, the most widely adopted strategy is the use of immunosuppressive drugs in triple therapy using calcineurin inhibitors, glucocorticoids, and nucleotide synthesis inhibitors. However, the use of these drugs is inherent to adverse effects, such as infection, malignancy, and drug toxicity. OBJECTIVE: To analyze adverse effects secondary to maintenance immunosuppressive therapy after heart transplantation. METHODOLOGY: A careful search of original scientific articles was carried out in the PubMed database between 2018 and 2023, according to the established PRISMA guidelines. The inclusion criteria were original studies, clinical studies, which presented the descriptors in the title or abstract and written in English. RESULTS: After using the inclusion criteria, 35 studies were found. However, only 04 were published. The studies show that the association between Tacrolimus and Everolimus can result in the development of left ventricular hypertrophy (LVH). In addition, the drug tacrolimus can be associated with the appearance of fibrosis, ischemic heart failure and hypomagnesemia. Children and adolescents medicated with prolonged or immediate release Tacrolimus present diarrhea, hypertension and increased creatinine. In addition, studies based on standard therapy with Cyclosporine show the development of deterioration of renal function. CONCLUSION: The use of immunosuppressive drugs is extremely important to avoid graft rejection and increase the individual's survival. However, the use of such drugs can cause adverse effects, which compromise the patient's quality of life. Therefore, it is important to develop further studies, aiming to contribute to the use of these medications and knowledge about potential adverse effects.