Clinical experience with Certican (everolimus) in maintenance heart transplant patients at the Medical University of Vienna.
Innovations in immunosuppressant therapy often transfer from renal transplantation to heart transplantation. Accordingly, there is growing interest in calcineurin inhibitor (CNI)- and steroid-sparing regimens for heart transplant patients. The novel proliferation signal inhibitor, Certican (everolimus), has been shown to allow reduced CNI exposure in renal transplant recipients without loss of efficacy. It has also demonstrated efficacy for reducing biopsy-proven acute rejection (BPAR) and cardiac allograft vasculopathy (CAV) in de novo heart transplantation. The present study reports early clinical experience of introducing everolimus as maintenance immunosuppression in heart transplant recipients whose previous regimen had failed. A 58-year-old woman received an organ from a 56-year-old female donor. She was prescribed cyclosporine for micromemulsion (CsA; Neoral), azathioprine, prednisolone and atorvastatin. After 3 months, azathioprine was switched to mycophenolate mofetil (MMF). At Month 27, the patient experienced Grade 3A BPAR, had a left ventricular ejection fraction (LVEF) of 20%, and compromised renal function. After steroid boluses to control BPAR, everolimus 3.0 mg/day was prescribed, while CsA and prednisolone doses were reduced. One month later, the patient contracted herpes labialis and pneumonia, and creatinine was elevated; CsA was stopped, everolimus dose was reduced to 1.5 mg/day and prednisolone reduced further. After another month, LVEF recovered to 50% and creatinine was 1.29 mg/dl. There was evidence of hyperlipidemia, which responded to atorvastatin 10 mg. For maintenance immunosuppression after heart transplantation, everolimus may allow CsA dose reduction and could be efficacious in combination with MMF. Further studies are required to confirm its efficacy and effects on CAV.
Zuckermann
Andreas
A
Department of Cardio-Thoracic Surgery, Medical University of Vienna, A-1090 Vienna, Austria. andreas.zuckermann@chello.at
D000046:Academic Medical Centers; D001317:Austria; D000068338:Everolimus; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008875:Middle Aged; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus