Rejection after conversion to a proliferation signal inhibitor in chronic heart transplantation.

Autores de IIS La Fe

• Luis Almenar Bonet

  Autor

• 

  Luis Vicente Martínez Dolz

  Autor

Participantes ajenos a IIS La Fe

• González-Vílchez F
• Vázquez de Prada JA
• Paniagua MJ
• Mirabet S
• Gómez-Bueno M
• Díaz-Molina B
• Arizón JM
• Delgado J
• Pérez-Villa F
• Crespo-Leiro MG
• Roig E
• Segovia J
• Lambert JL
• Lopez-Granados A
• Escribano P
• Farrero M

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

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 CNIs were replaced with a PSI (sirolimus or everolimus) between October 2001 and March 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.

Keywords

• cardiac transplantation, complications, everolimus, rejection, sirolimus