Use of rapamycin slows progression of cardiac transplantation vasculopathy.
BACKGROUND
Cardiac transplantation vasculopathy is the leading cause of late death in heart transplantation recipients. Rapamycin is an immunosuppressant drug with potent antiproliferative and antimigratory effects. We investigated whether rapamycin could prevent progression of graft vasculopathy in 46 patients (age, 54+/-10 years; 4.3+/-2.3 years after transplantation) with severe disease.


RESULTS
At annual cardiac catheterization, patients were randomly assigned to treatment with rapamycin (n=22) versus continued current immunosuppression (n=24). Clinical characteristics including recipient age and sex, underlying cause of congestive heart failure, donor age and sex, and ischemic time were recorded. Cardiac catheterization was graded with the use of a semiquantitative scale and repeated annually. Clinically significant adverse events were defined as death, need for angioplasty or bypass surgery, myocardial infarction, and a >25% worsening of the catheterization score. These events were monitored as primary study end points. Anti-HLA class I and II antibody production and lymphocyte growth assays were measured with each biopsy. Patients selected for rapamycin had azathioprine or mycophenolate mofetil discontinued and were given rapamycin. Outcomes were compared by means of log-rank analysis. There were no significant differences in baseline characteristics. Duration of follow-up was comparable (rapamycin, 689+/-261; control, 630+/-207 days; NS). In the rapamycin group, 3 patients reached primary end points versus 14 patients in the control group (P<0.001). There was no difference in baseline or subsequent anti-HLA class I or II antibody production.


CONCLUSIONS
In this patient cohort with cardiac vasculopathy, treatment with rapamycin slowed disease progression probably by its antiproliferative and antimigratory effects.
Columbia University, New York, NY, USA. dmm31@columbia.edu
Donna
D
Mancini
Sean
S
Pinney
Daniel
D
Burkhoff
John
J
LaManca
Silviu
S
Itescu
Elizabeth
E
Burke
Niloo
N
Edwards
Mehmet
M
Oz
Andrew R
AR
Marks
D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D001323:Autoantibodies / Q000097:blood; D006328:Cardiac Catheterization; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000209:etiology / Q000517:prevention & control; D016572:Cyclosporine / Q000097:blood / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology; D020123:Sirolimus / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome
D001323:Autoantibodies; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D020123:Sirolimus