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Conversion to everolimus in pediatric heart transplant recipients is a safe treatment option with an impact on cardiac allograft vasculopathy and renal function
Author(s) -
Grimm Kathrin,
Lehner Anja,
Fernandez Rodriguez Silvia,
Orban Madeleine,
Fischer Marcus,
Rosenthal Laura L.,
Jakob Andre,
Haas Nikolaus A.,
Dalla Pozza Robert,
KozlikFeldmann Rainer,
Ulrich Sarah M.
Publication year - 2021
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.14191
Subject(s) - medicine , everolimus , heart transplantation , nephrotoxicity , renal function , transplantation , cytomegalovirus , single center , nephrology , urology , cardiac function curve , cardiology , retrospective cohort study , kidney , heart failure , immunology , virus , viral disease , herpesviridae
Abstract Background Cardiac allograft vasculopathy (CAV) and nephrotoxicity affect long‐term survival after heart transplantation (HTX). Studies, mostly conducted in adults, showed a positive effect of everolimus (EVL) on these problems. We describe the effects of conversion of the immunosuppressive therapy to an everolimus including regime on CAV, renal function, and safety in heart transplanted children/adolescents. Methods This retrospective single‐center study included 36 participants (mean time after HTX 6.3 ± 4.7 years). Descriptive pre/post‐comparisons were performed with an observation period partially up to 4 years. Impact on CAV was assessed based on intravascular imaging and Stanford grading. Safety analysis included cytomegalovirus (CMV)‐infection and acute rejection. Results In terms of CAV (9 out of 36 patients) four showed no progression, three an improvement, one a worsening; one new diagnosis. The average CrCl showed a significant improvement 6, 12, and 24 months after conversion regarding all patients (n = 29). There was no acute rejection or CMV‐infection. Conclusion Conversion to an EVL‐based therapy after pediatric HTX is a safe immunosuppressive regime without increasing risk of acute rejection or CMV‐infection. There was some evidence of reduction in progression of CAV and a significant improvement of the renal function.