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First Experience with de novo Calcineurin‐Inhibitor‐Free Immunosuppression Following Cardiac Transplantation
Author(s) -
Meiser Bruno,
Reichart Bruno,
Adamidis Ioannis,
Überfuhr Peter,
Kaczmarek Ingo
Publication year - 2005
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.00757.x
Subject(s) - medicine , calcineurin , immunosuppression , sirolimus , adverse effect , mycophenolic acid , transplantation , urology , heart transplantation , mycophenolate , hypertriglyceridemia , gastroenterology , trough level , tacrolimus , surgery , cholesterol , triglyceride
The aim of this pilot study was to investigate whether de novo calcineurin‐inhibitor‐free immunosuppression after cardiac transplantation is efficacious and can prevent post‐operative renal impairment. Eight patients were treated by combining trough level adjusted sirolimus and mycophenolate mofetil; corticosteroids were given for the first 6 post‐operative months only. Survival data, acute rejection episodes and adverse events with a special emphasis on renal impairment, myelosuppression, hypercholesterolemia, hypertriglyceridemia and infections, were recorded. With a follow‐up of 3–12 months, patient survival was 100% and freedom from rejection 75%. The mean creatinine levels initially decreased and remained stable thereafter. A moderate myelosuppressive effect did not necessitate dose reduction of immunosuppressants, intermittently elevated cholesterol‐ and triglyceride levels decreased over time. Most frequent adverse events were pericardial effusions and peripheral edema. Complete abandonment of calcineurin inhibitor therapy by de novo use of the combination sirolimus/mycophenolate mofetil resulted in low rejection rate and avoidance of renal impairment, but should not be used without further evaluation of potential complications in a lager setting.