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To this day, heart transplant is the treatment of choice in patients with heart disease and functional repercussions that is refractory to treatment (both drugs and electrical or mechanical devices) and has no contraindications. The milestone that made heart transplant take the spotlight in the management of these patients was the introduction of calcineurin inhibitors as basic immunosuppressants, which allowed the effective control of acute graft rejection. Immunosuppression patterns based on cyclosporine at the beginning and then on tacrolimus have led to really long survivals with means of up to 12 years.1 After acute rejection was no longer the main cause of graft failure and occasionally the patient, the long-term survival of the graft is basically limited by the development of coronary vascular disease.

Cardiac allograft vasculopathy. A disease on the search for therapy