Treatment With mTOR Inhibitors as Primary Immunosuppression After Combined Heart and Kidney Transplantation.

Autor: Alnsasra H; Department of Cardiovascular Diseases and Health Sciences Research and the William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA; Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva P.O. Box 653, Israel; Department of Cardiology, Soroka University Medical Center, Rager Av., Beersheva P.O. Box 84101, Israel., Asleh R; Department of Cardiovascular Diseases and Health Sciences Research and the William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA; Heart Institute, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem P.O. Box 12000, Israel., Khalil F; Department of Cardiovascular Diseases and Health Sciences Research and the William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA., Akiki E; Department of Cardiovascular Diseases and Health Sciences Research and the William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA., Briasoulis A; Department of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA., Dean PG; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA., Bentall AJ; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA., Kushwaha SS; Department of Cardiovascular Diseases and Health Sciences Research and the William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA. Electronic address: kushwaha.sudhir@mayo.edu.
Jazyk: angličtina
Zdroj: Journal of cardiac failure [J Card Fail] 2024 Dec 07. Date of Electronic Publication: 2024 Dec 07.
DOI: 10.1016/j.cardfail.2024.10.451
Abstrakt: Aims: Sirolimus (SRL) mitigates cardiac allograft vasculopathy (CAV) progression and confers renal protection after heart transplantation (HT). However, its safety and efficacy in patients undergoing combined heart and kidney transplantation (HKT) are unclear. This study aimed to investigate the impact of conversion from calcineurin inhibitors (CNI) to SRL on CAV progression, renal function, and outcomes in HKT compared to isolated HT.
Methods and Results: A cohort of 302 patients who underwent either HT only (n=262) or HKT (n=40) was analyzed. CAV progression was assessed by measuring the delta (Δ) annual change in plaque volume (PV) and plaque index (PI) using coronary intravenous ultrasound (IVUS). Clinical adverse outcomes included all-cause death and CAV-associated events. Overall, 217 (72%) patients were converted from CNI to SRL as primary immunosuppression. HT recipients were more likely to be converted to SRL than HKT recipients (74% vs. 55%, P=0.01). HKT was associated with higher ΔPV (P=0.01) and a trend toward higher ΔPI (P=0.06) than HT-only, but this association was attenuated after adjustment to SRL conversion. HKT was associated with similar risk of death (HR 0.98, 95%CI: 0.39-2.5, P=0.97) and CAV-related events (HR 1.6, 95%CI: 0.91-2.8, P=0.10). Conversion to SRL was associated with decreased risk of death and CAV-related events in the overall cohort. This association was not modified by the type of organ transplantation and without a significant effect on estimated glomerular filtration rate or proteinuria.
Conclusion: Conversion to sirolimus as a primary immunosuppressant could be effective for either HT-only or HKT recipients.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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