当前位置： SCI文献检索 > TRANSPLANTATION PROCEEDINGS期刊下所有文献 > Increased incidence of acute graft rejection on calcineurin inhibitor-free immunosuppression after heart transplantation.

Increased incidence of acute graft rejection on calcineurin inhibitor-free immunosuppression after heart transplantation.

Abstract：

BACKGROUND:Calcineurin inhibitor (CNI)-free immunosuppression is used increasingly after heart transplantation to avoid CNI toxicity, but in the absence of a randomized trial, concerns remain over an increased rejection risk. METHODS:We studied the incidence of graft rejection episodes among all cardiac graft recipients, beginning with the first introduction of CNI-free protocols. We compared events during CNI-free and CNI-containing immunosuppression among 231 transplant recipients of overall mean age 55.2 ± 11.8 years, from a mean 5.2 ± 5.4 years after transplantation through a mean follow-up of 3.1 ± 1.4 years. We considered as acute rejection episodes requiring treatment those of International Society for Heart and Lung Transplantation. RESULTS:During the total follow-up of 685 patient years (CNI-containing, 563; CNI-free, 122), we performed 1,374 biopsies which diagnosed 78 rejection episodes. More biopsies were performed in CNI-free patients: biopsies/patient-month of CNI-containing, 0.13 versus CNI-free, 0.22 (P < .05). The incidence of rejection episodes per patient-month was significantly higher on CNI-free compared with CNI therapy, among patients switched both early and later after heart transplantation, namely, within 1 year, 0.119 versus 0.035 (P = .02); beyond 1 year, 0.011 versus 0.004 (P = .007); beyond 2 years, 0.007 versus 0.003 (P = .04); and beyond 5 years: 0.00578 versus 0.00173 (P = .04). CONCLUSIONS:Rejection incidence during CNI-free immunosuppression protocols after heart transplantation was significantly increased in both early and later postoperative periods. Given the potentially long delay to rejection occurrence, patients should be monitored closely for several months after a switch to CNI-free immunosuppressive protocols.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Celik S,Doesch AO,Konstandin MH,Kristen AV,Ammon K,Sack FU,Schnabel P,Katus HA,Dengler TJ

doi

10.1016/j.transproceed.2010.12.059

subject

Has Abstract

pub_date

2011-06-01 00:00:00

pages

1862-7

issue

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(11)00271-5

journal_volume

pub_type

临床试验,杂志文章

在线工具

Increased incidence of acute graft rejection on calcineurin inhibitor-free immunosuppression after heart transplantation.