Portal de investigación
Use of mTOR inhibitors in chronic heart transplant recipients with renal failure: Calcineurin-inhibitors conversion or minimization?
Autores de IIS La Fe
Participantes ajenos a IIS La Fe
- Gonzalez-Vilchez F
- Vazquez de Prada JA
- Paniagua MJ
- Gomez-Bueno M
- Arizon JM
- Roig E
- Delgado J
- Lambert JL
- Perez-Villa F
- Sanz-Julve ML
- Crespo-Leiro M
- Lopez-Granados A
- Escribano P
- Diaz-Molina B
- Farrero M
- Blasco T
Grupos
Abstract
Background: In the last decade, mTOR inhibitors (mTOR-is) have become the cornerstone of the calcineurin inhibitor (CNI)-reduced/free regimens aimed to the preservation of post-transplant renal function. We compared utility and safety of the total replacement of calcineurin inhibitors with a mTOR-i with a strategy based on calcineurin inhibitor minimization and concomitant use of m-TOR-i. Methods: In a retrospective multi-center cohort of 394 maintenance cardiac recipients with renal failure (GFR - 60 mL/min/1.73 m(2)), we compared 235 patients in whom CNI was replaced with a mTOR-i (sirolimus or everolimus) with 159 patients in whom mTOR-is were used to minimize CNIs. A propensity score analysis was carried out to balance between group differences. Results: Overall, after a median time of 2 years from mTOR-i initiation, between group differences for the evolution of renal function were not observed. In a multivariate adjusted model, improvement of renal function was limited to patients with mTOR-i usage within 5 years after transplantation, particularly with the conversion strategy, and in those patients who could maintain mTOR-i therapy. Significant differences between strategies were not found for mortality, infection and mTOR-i withdrawal due to drug-related adverse events. However, conversion group tended to have a higher acute rejection incidence than the minimization group (p = 0.07). Conclusion: In terms of renal benefits, our results support an earlier use of mTOR-is, irrespective of the strategy. The selection of either a conversion or a CNI minimization protocol should be based on the clinical characteristics of the patients, particularly their rejection risk. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
Datos de la publicación
- ISSN/ISSNe:
- 0167-5273, 1874-1754
- Tipo:
- Article
- Páginas:
- 15-23
- PubMed:
- 24309084
- Factor de Impacto:
- 1,353 SCImago ℠
- Cuartil:
- Q1 SCImago ℠
INTERNATIONAL JOURNAL OF CARDIOLOGY ELSEVIER IRELAND LTD
Citas Recibidas en Web of Science: 29
Documentos
- No hay documentos
Filiaciones
Keywords
- Cardiac transplantation; Renal function; Immunosuppression; Sirolimus; Everolimus
Campos de Estudio
Cita
Gonzalez F,Vazquez de Prada JA,Paniagua MJ,Gomez M,Arizon JM,ALMENAR L,Roig E,Delgado J,Lambert JL,Perez F,Sanz ML,Crespo M,SEGOVIA J,Lopez A,MARTINEZ L,MIRABET S,Escribano P,Diaz B,Farrero M,Blasco T. Use of mTOR inhibitors in chronic heart transplant recipients with renal failure: Calcineurin-inhibitors conversion or minimization?. Int. J. Cardiol. 2014. 171. (1):p. 15-23. IF:4,036. (1).