Rejection after conversion to a proliferation signal inhibitor in chronic heart transplantation.

Abstract:

:We sought to determine the incidence, risk factors, and consequences of acute rejection (AR) after conversion from a calcineurin inhibitor (CNI) to a proliferation signal inhibitor (PSI) in maintenance heart transplantation. Relevant clinical data were retrospectively obtained for 284 long-term heart transplant recipients from nine centers in whom CNIs were replaced with a PSI (sirolimus or everolimus) between October 2001 and March 2009. The rejection rate at one yr was 8.3%, stabilizing to 2% per year thereafter. The incidence rate after conversion (4.9 per 100 patient-years) was significantly higher than that observed on CNI therapy in the pre-conversion period (2.2 per 100 patient-years). By multivariate analysis, rejection risk was associated with a history of late AR prior to PSI conversion, early conversion (<5 yr) after transplantation and age <50 yr at the time of conversion. Use of mycophenolate mofetil was a protective factor. Post-conversion rejection did not significantly influence the evolution of left ventricular ejection fraction, renal function, or mortality during further follow-up. Conversion to a CNI-free immunosuppression based on a PSI results in an increased risk of AR. Awareness of the clinical determinants of post-conversion rejection could help to refine the current PSI conversion strategies.

journal_name

Clin Transplant

journal_title

Clinical transplantation

authors

González-Vílchez F,Vázquez de Prada JA,Paniagua MJ,Almenar L,Mirabet S,Gómez-Bueno M,Díaz-Molina B,Arizón JM,Delgado J,Pérez-Villa F,Crespo-Leiro MG,Martínez-Dolz L,Roig E,Segovia J,Lambert JL,Lopez-Granados A,Escribano P

doi

10.1111/ctr.12241

subject

Has Abstract

pub_date

2013-11-01 00:00:00

pages

E649-58

issue

6

eissn

0902-0063

issn

1399-0012

journal_volume

27

pub_type

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