Recent advances in immune rejection and immunosuppressive therapy in heart transplantation

Abstract Heart transplantation is the ultimate treatment for eligible patients with end-stage heart disease, but its success and long-term prognosis face dual challenges of immune rejection and complications associated with immunosuppressive therapy. This article reviews the recent advances in the field of immunotherapy for heart transplantation. First, in terms of rejection mechanism and monitoring, the classification of hyperacute, acute and chronic rejection is introduced, and the application of new non-invasive biomarkers in early and precise monitoring of rejection is emphasized. Secondly, in terms of immunosuppressive therapy, the common drug regimens, mechanism of action and comparison of advantages and disadvantages of induction therapy, maintenance therapy and rescue therapy are systematically analyzed, and the clinical application and adverse reaction management of traditional calcineurin inhibitors, anti-proliferative agents and new proliferative signal inhibitors are summarized. Finally, the article focuses on the latest research directions and future trends in this field, and pays attention to the differences in the effects of immunosuppressive therapy in different ethnic and socioeconomic groups. These advances jointly promote the development of heart transplant immunotherapy in a more efficient, low-toxicity, and individualized direction, aiming to improve the long-term survival and quality of life of patients.