Cardiac allograft vasculopathy (CAV)—mediated by a heterogeneous myriad of immune and non-immune factors, which contribute to the progressive and diffuse thickening of the arterial allograft's tunica intima in one distinct form of CAV, and the build-up of plaque in another—is a major limiting factor of long-term survival post heart transplantation. Information on the optimal pharmacotherapeutic approaches for the prevention and management of CAV is conflicting, scattered, and inconsistent, with numerous recent studies adding to the literature. In this paper, we present a go-to clinical resource with the most updated and comprehensive information on the topic. Immunosuppressant therapy remains a staple, with mTOR inhibitors and mycophenolate mofetil (MMF) showing direct correlation with CAV prevention. More data is now available with calcineurin inhibitor (CNI) minimizing or sparing regimens. More novel approaches are being investigated for the roles of monoclonal antibodies, anti-thymocyte globulin, and bortezomib in preventing or delaying CAV. On the other hand, statins' established efficacy is attributed to lipid-lowering and lipid-independent immunomodulatory effects, with early initiation associated with improved outcomes. The choice of statin is dependent on drug-drug interactions. Other aiding approaches for the prevention of CAV include antioxidant vitamins, aspirin, vasodilators, folate therapy, and, most pertinently, cytomegalovirus prophylaxis. Larger clinical trials are needed before these options are institutionalised. For management of established CAV, early initiation of augmented immunosuppressive therapies may be effective, as well as CNI conversion to mTOR inhibitors with or without standard MMF and azathioprine therapy. Risk of acute rejection needs to be monitored during conversion. Finally, preclinical investigations highlight novel potential therapies for CAV prevention and attenuation, however robust clinical trials are needed to test their efficacy and safety.

心脏同种异体移植血管病变 (CAV)——由多种异质性免疫和非免疫因素介导，导致一种不同形式的 CAV 中同种异体动脉内膜进行性和弥漫性增厚，以及另一种形式的斑块积聚——是心脏移植后长期存活的主要限制因素。关于预防和管理 CAV 的最佳药物治疗方法的信息是相互矛盾的、分散的和不一致的，许多最近的研究增加了文献。在本文中，我们提供了一个临床资源，其中包含有关该主题的最新和最全面的信息。免疫抑制剂治疗仍然是主要药物，mTOR 抑制剂和吗替麦考酚酯 (MMF) 显示出与 CAV 预防直接相关。现在可以获得更多关于钙调神经磷酸酶抑制剂 (CNI) 最小化或保留方案的数据。正在研究更多新方法，以了解单克隆抗体、抗胸腺细胞球蛋白和硼替佐米在预防或延迟 CAV 中的作用。另一方面，他汀类药物的既定疗效归因于降脂和非脂质依赖性免疫调节作用，早期开始使用与改善结果相关。他汀类药物的选择取决于药物-药物相互作用。其他预防 CAV 的辅助方法包括抗氧化维生素、阿司匹林、血管扩张剂、叶酸疗法，以及最相关的巨细胞病毒预防。在这些选择制度化之前，需要进行更大规模的临床试验。对于已建立的 CAV 的管理，早期开始增强免疫抑制治疗可能是有效的，以及在有或没有标准 MMF 和硫唑嘌呤治疗的情况下 CNI 转换为 mTOR 抑制剂。在转换期间需要监测急性排斥反应的风险。最后，临床前研究强调了预防和减弱 CAV 的新型潜在疗法，但需要强有力的临床试验来测试其有效性和安全性。