Conversion from calcineurin inhibitors to mTOR inhibitors as primary immunosuppressive drugs in pediatric heart transplantation. Clin Transplant 2017 Oct;31(10)
Date
07/15/2017Pubmed ID
28708333DOI
10.1111/ctr.13054Scopus ID
2-s2.0-85030676601 (requires institutional sign-in at Scopus site) 16 CitationsAbstract
There are only a few reports of successful use of mammalian target of rapamycin (mTORI) as primary immunosuppression in pediatric heart transplantation. Compared to calcineurin inhibitors, mTORI have less side effects, especially nephrotoxicity, infections, and malignancies. A retrospective study was conducted at our institution of all 170 heart transplants from 1995 to 2015. Nineteen patients were switched from tacrolimus (n=15) or cyclosporin (n=4) to everolimus (n=4) or sirolimus (n=15) due to nephrotoxicity (n=5), malignancy (n=8), EBV viremia/reactive plasmacytic changes (n=5), and immune hemolytic anemia (n=1). We monitored for rejection, infection, BUN, creatinine, hyperlipidemia, EBV and CMV copies, CBC, cardiac allograft vasculopathy (CAV), and death. Target trough levels of sirolimus and everolimus were 4-10. Four treatment failures included debilitating rash, bone marrow suppression, recurrent rejection, and renal transplantation. There were no deaths. One patient had recurrent rejection episodes, and tacrolimus was reinitiated. One patient with preexisting CAV underwent heart retransplantation. One patient, who was treated for PTLD, transformed to CD30+ Hodgkins disease, and was treated with brentuximab. There were three acute rejection episodes. Median creatinine preswitch was higher 0.82 than postswitch 0.78 (P=.016). Median eGFR was lower preswitch, 75.6, than postswitch, 91.2 (P=.0004). These results indicate that conversion to mTORI as primary immunosuppression may be safely accomplished in some pediatric heart transplant patients.
Author List
Asante-Korang A, Carapellucci J, Krasnopero D, Doyle A, Brown B, Amankwah EAuthor
Ernest Amankwah PhD Director, Associate Professor in the Clinical and Translational Science Institute department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Calcineurin InhibitorsChild
Child, Preschool
Female
Follow-Up Studies
Graft Rejection
Graft Survival
Heart Transplantation
Humans
Immunosuppressive Agents
Infant
Infant, Newborn
Male
Postoperative Complications
Prognosis
Retrospective Studies
Risk Factors
TOR Serine-Threonine Kinases
