Systemic immunosuppressive therapy inhibits in-stent restenosis in patients with renal allograft.
BACKGROUND
Cyclosporine is used routinely for prophylaxis for renal allograft rejection. In experimental animal studies, cyclosporine had been shown to inhibit smooth muscle cell proliferation during the arterial response to injury. We investigated whether systemic immunosuppression may inhibit in-stent restenosis in renal transplant patients undergoing coronary stenting.


METHODS
From 1993 to 2003, 33 renal transplant patients with 45 coronary lesions and 37 dialysis patients with 52 lesions underwent coronary stenting using bare metal stents at our center. We followed all patients clinically for a mean period of 37 +/- 31 months and 40 patients angiographically at 14 +/- 15 months after coronary intervention. Cyclosporine was combined with corticosteroids in 32 patients and one patient received tacrolimus instead of cyclosporine.


RESULTS
The baseline clinical and angiographical characteristics were similar and the success rate of the procedure was 100% in both groups. In renal transplant group, the mean dose of cyclosporine was 192.5 +/- 68 mg/day and the blood cyclosporine level at the time of procedure was 152.9 +/- 51.5 ng/mL. The rate of in-stent restenosis was 7.1% in renal transplant group and 57.1% in dialysis group (P < 0.0001). The mean late loss was 0.47 +/- 0.57 mm in renal transplant group when compared with 1.51 +/- 1.09 mm in dialysis group (P = 0.004). The overall rate of major adverse cardiac events (MACEs) was 6.1% in renal transplant group and 35.1% in dialysis group (P < 0.0001).


CONCLUSIONS
Renal transplant patients receiving combined immunosuppressive agents showed markedly low rates of in-stent restenosis and MACE after coronary revascularization with stent. We consider that this result may be related to the ability of combined immunosuppressive therapy to inhibit inflammatory reaction and vascular smooth muscle cell proliferation induced by coronary stenting.
Jung
Jae-Hun
JH
Cardiovascualr Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea.
Min
Pil-Ki
PK
Kim
Jong-Youn
JY
Park
Sungha
S
Choi
Eui-Young
EY
Ko
Young-Guk
YG
Choi
Donghoon
D
Jang
Yangsoo
Y
Shim
Won-Heum
WH
Cho
Seung-Yun
SY
D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D023903:Coronary Restenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D003524:Cyclosporins / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015607:Stents; D016559:Tacrolimus / Q000627:therapeutic use; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D003524:Cyclosporins; D007166:Immunosuppressive Agents; D016559:Tacrolimus