title: Preventive treatment of coronary vasculopathy in heart transplantation by inhibition of smooth muscle cell proliferation with angiopeptin.
abstract: BACKGROUND
  The underlying mechanism of accelerated coronary vasculopathy in cardiac allografts still remains unclear. Our hypothesis was that inhibition of smooth muscle cell proliferation with the somatostatine analogue Angiopeptin may reduce vasculopathy.
  
  
  METHODS
  Fifty-four patients received Angiopeptin injections (1500 micrograms x three times daily subcutaneously) for 21 days after the operation and three additional injections with every rejection treatment. Angiography was performed yearly, and data were compared with a matched historic control group.
  
  
  RESULTS
  Actuarial survival was 85% at 1 year and 80% at 2 years, comparable with our results in general (80%/77%). Forty-six long-term survivors could be followed by coronary angiography. At 1 year, vasculopathy was assessed in nine patients (17%). Of the 18 patients investigated at 2 years thus far, an additional three patients were found to have vasculopathy. In the control group vasculopathy was comparable, being 13% after 1 year and 20% after 2 years. A significantly lower incidence of rejections and lower creatinine values were found in the study group within the entire observation period (p < 0.05).
  
  
  CONCLUSIONS
  We conclude that Angiopeptin treatment appears to be safe without significant side effects; it may reduce the number of acute rejections, at least during the first year after heart transplantation. However, the results of the 2-year follow-up in the remaining patients would have to be included in assessing the effect of Angiopeptin. Long-term follow-up will be necessary to decide whether Angiopeptin will be helpful in reducing the incidence of transplant vasculopathy.
authors.affiliation: Department of Cardiothoracic Surgery, Hannover Medical School, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Wahlers
authors.forename: A
authors.initials: A
authors.lastname: Mügge
authors.forename: P
authors.initials: P
authors.lastname: Oppelt
authors.forename: B
authors.initials: B
authors.lastname: Heublein
authors.forename: H G
authors.initials: HG
authors.lastname: Fieguth
authors.forename: M J
authors.initials: MJ
authors.lastname: Jurmann
authors.forename: K
authors.initials: K
authors.lastname: Uthoff
authors.forename: A
authors.initials: A
authors.lastname: Haverich
authors.forename: J M
authors.initials: JM
authors.lastname: Albes
authors.forename: M
authors.initials: M
authors.lastname: Foegh
mesh_terms: D000206:Actuarial Analysis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000187:drug effects*; D009842:Oligopeptides / Q000627:therapeutic use*; D010456:Peptides, Cyclic; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D009842:Oligopeptides; D010456:Peptides, Cyclic; C060347:lanreotide; D013004:Somatostatin