Faculty Collaboration Database

Conversion to sirolimus as primary immunosuppression attenuates the progression of allograft vasculopathy after cardiac transplantation. Circulation 2007 Dec 04;116(23):2726-33

Date

11/21/2007

Pubmed ID

18025531

DOI

10.1161/CIRCULATIONAHA.107.692996

Scopus ID

2-s2.0-37349072494 (requires institutional sign-in at Scopus site)   151 Citations

Abstract

BACKGROUND: We investigated the potential of conversion to sirolimus (SRL) as a primary immunosuppressant in attenuating cardiac allograft vasculopathy progression.

METHODS AND RESULTS: Twenty-nine cardiac transplant recipients were converted to SRL 3.8+/-3.4 years after transplantation with complete calcineurin inhibitor (CNI) withdrawal. Secondary immunosuppressants (azathioprine or mycophenolate) and steroids remained unchanged. Forty patients (controls) 4.8+/-4.0 years from transplantation were maintained on CNIs. Three-dimensional intravascular ultrasound studies were performed at baseline and 12.1+/-2.6 months later. Mean plaque (media and intima) volume (PV) and plaque index (PI) (PV/vessel volume percent) increased significantly in the CNI group (1.28+/-2.86 mm(3)/mm, P=0.004; and 6+/-8%, P=0.0001) but not in the SRL group (0.1+/-1.13 mm(3)/mm, P=0.63; and 0.1+/-8%, P=0.94). In patients enrolled within 2 years after transplantation, the increases in PV (0.06+/-1.06 versus 1.77+/-1.65 mm(3)/mm; P=0.0081) and PI (0+/-9% versus 10+/-8%; P=0.0145) were smaller in the SRL group (n=11) than in the CNI (n=12) group. In patients enrolled >/=2 years after transplantation, the increase in PI was less in the SRL group compared with the CNI group (0.1+/-6.5% versus 5+/-8%; P=0.033), but changes in PV did not differ significantly. Treatment with azathioprine or mycophenolate did not affect PV or PI in either the SRL group (PV: 0.22+/-0.66 versus 0.05+/-1.45 mm(3)/mm, P=0.46; PI: 1.5+/-6% versus -1.6+/-8.5%, P=0.29) or the CNI group (PV: 1.42+/-1.39 versus 1.06+/-2.28 mm(3)/mm, P=0.49; PI: 7.8+/-8.7% versus 4.8+/-7.3%, P=0.23).

CONCLUSIONS: Substituting CNI with SRL as primary immunosuppression attenuates cardiac allograft vasculopathy progression.

Author List

Raichlin E, Bae JH, Khalpey Z, Edwards BS, Kremers WK, Clavell AL, Rodeheffer RJ, Frantz RP, Rihal C, Lerman A, Kushwaha SS

Author

Eugenia Raichlin MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenal Cortex Hormones
Adult
Aged
Azathioprine
Coronary Disease
Female
Heart Transplantation
Humans
Immunosuppressive Agents
Male
Middle Aged
Mycophenolic Acid
Sirolimus
Transplantation, Homologous