Drug therapy in the heart transplant recipient: Part III: common medical problems.

Continued improvement in the long-term survival of heart transplant recipients has resulted in a population of patients with prolonged exposure to immunosuppressive drugs.1 This exposure, coupled with the increasing age of recipients, has resulted in an impressive prevalence of comorbidities in these patients. Indeed, by 5 years after transplantation, 95% of recipients have hypertension, 81% have hyperlipidemia, and 32% have diabetes.1 In addition, 25% to 50% have coronary allograft vasculopathy (CAV), and up to 33% have chronic renal insufficiency.2–5 As more drugs are developed to both prevent and treat these problems and common infectious complications after transplantation, it is likely that the heart transplant recipient will be taking an increasing number of drugs. Because standard immunosuppressive drugs have a high potential for drug–drug interactions, the heart transplant recipient is subject to an enormous risk for drug–drug interactions. In this article, we briefly review common medical problems in heart transplant recipients that are routinely addressed with drug therapy. In Part IV of this series, we provide specific details of known important and common drug–drug interactions, along with recommendations for management.