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Rejection after conversion to a proliferation signal inhibitor in chronic heart transplantation
Author(s) -
GonzálezVílchez Francisco,
Vázquez de Prada José A.,
Paniagua María J.,
Almenar Luis,
Mirabet Sonia,
GómezBueno Manuel,
DíazMolina Beatriz,
Arizón Jose M.,
Delgado Juan,
PérezVilla Félix,
CrespoLeiro María G.,
MartínezDolz Luis,
Roig Eulalia,
Segovia Javier,
Lambert José L.,
LopezGranados Amador,
Escribano Pilar,
Farrero Marta
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12241
Subject(s) - medicine , calcineurin , heart transplantation , transplantation , immunosuppression , ejection fraction , everolimus , incidence (geometry) , urology , cardiology , surgery , heart failure , physics , optics
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 CNI s were replaced with a PSI (sirolimus or everolimus) between O ctober 2001 and M arch 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.