Long-Term Sirolimus for Primary Immunosuppression in Heart Transplant Recipients
| Autor: | Brooks S. Edwards, Amir Lerman, Jonella M Tilford, Walter K. Kremers, Woong Gil Choi, Robert P. Frantz, Barry A. Boilson, Richard J. Rodeheffer, Rabea Asleh, John A. Schirger, Rosalyn Adigun, Alexandros Briasoulis, Alfredo L. Clavell, Lyle D. Joyce, Simon Maltais, Richard C. Daly, Sudhir S. Kushwaha, John M. Stulak, Naveen L. Pereira |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Heart transplantation
medicine.medical_specialty medicine.diagnostic_test business.industry medicine.medical_treatment Urology Immunosuppression 030204 cardiovascular system & hematology 030230 surgery Cardiac allograft vasculopathy Calcineurin 03 medical and health sciences 0302 clinical medicine Maintenance therapy Sirolimus Cohort Intravascular ultrasound cardiovascular system medicine Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Journal of the American College of Cardiology. 71:636-650 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2017.12.005 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|