Date of Award

2024

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Andvik, Vicki

Keywords

Cardiac Allograft Vasculopathy, CAV, Pediatric, Heart Retransplantation, Everolimus, Sirolimus, Tacrolimus, Aspirin, Stent

Abstract

Coronary allograft vasculopathy (CAV) is the leading cause of morbidity and mortality among pediatric heart transplant recipients and faces unsuccessful treatment for prevention and management. Post-transplant immunosuppressive therapy has been modified over the years to determine the most effective regimen for rejection. Tacrolimus has been the superior immunosuppressant used for rejection since the early 2000s. It has been shown to have substantial immunosuppressive effects, least number of adverse effects, and decreased comorbidities compared to other regimens. Despite these advantages, CAV is still prevalent. Heart retransplantation is currently the only curative treatment. Google Scholar, PubMed, ClinicalKey, ScienceDirect, Elsevier, Wiley Online Library, and National Library of Medicine were used to compare current data on heart-conserving measures and heart retransplantation for CAV in the pediatric population. New drugs have become available that bear comparison with tacrolimus, such as everolimus and sirolimus. These drugs are shown to be more effective in long-term prevention and management of CAV than tacrolimus. Incorporating widely known drugs into treatment regimens, such as statins and aspirin, have been observed to have no effect on chronic rejection. Advanced technology has produced drug-eluting stents small enough for pediatric patients for short-term use as restenosis is inevitable. Heart retransplantation is inferior to heart-conserving measures as complications decrease life expectancy significantly more.

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