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Long-Term Sirolimus for Primary Immunosuppression in Heart Transplant Recipients.

Abstract：

BACKGROUND:Small studies have reported superiority of sirolimus (SRL) over calcineurin inhibitor (CNI) in mitigating cardiac allograft vasculopathy (CAV) after heart transplantation (HT). However, data on the long-term effect on CAV progression and clinical outcomes are lacking. OBJECTIVES:The aim of this study was to test the long-term safety and efficacy of conversion from CNI to SRL as maintenance therapy on CAV progression and outcomes after HT. METHODS:A cohort of 402 patients who underwent HT and were either treated with CNI alone (n = 134) or converted from CNI to SRL (n = 268) as primary immunosuppression was analyzed. CAV progression was assessed using serial coronary intravascular ultrasound during treatment with CNI (n = 99) and after conversion to SRL (n = 235) in patients who underwent at least 2 intravascular ultrasound studies. RESULTS:The progression in plaque volume (2.8 ± 2.3 mm3/mm vs. 0.46 ± 1.8 mm3/mm; p < 0.0001) and plaque index (plaque volume-to-vessel volume ratio) (12.2 ± 9.6% vs. 1.1 ± 7.9%; p < 0.0001) were significantly attenuated when treated with SRL compared with CNI. Over a mean follow-up period of 8.9 years from time of HT, all-cause mortality occurred in 25.6% of the patients and was lower during treatment with SRL compared with CNI (adjusted hazard ratio: 0.47; 95% confidence interval: 0.31 to 0.70; p = 0.0002), and CAV-related events were also less frequent during treatment with SRL (adjusted hazard ratio: 0.35; 95% confidence interval: 0.21 to 0.59; p < 0.0001). Further analyses suggested more attenuation of CAV and more favorable clinical outcomes with earlier conversion to SRL (≤2 years) compared with late conversion (>2 years) after HT. CONCLUSIONS:Early conversion to SRL is associated with attenuated CAV progression and with lower long-term mortality and fewer CAV-related events compared with continued CNI use.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Asleh R,Briasoulis A,Kremers WK,Adigun R,Boilson BA,Pereira NL,Edwards BS,Clavell AL,Schirger JA,Rodeheffer RJ,Frantz RP,Joyce LD,Maltais S,Stulak JM,Daly RC,Tilford J,Choi WG,Lerman A,Kushwaha SS

doi

10.1016/j.jacc.2017.12.005

subject

Has Abstract

pub_date

2018-02-13 00:00:00

pages

636-650

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(17)41867-5

journal_volume

pub_type

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Long-Term Sirolimus for Primary Immunosuppression in Heart Transplant Recipients.