Evolutional changes in maintenance immunosuppression following heart transplantation.
Patients with a heart transplant (HT) may require changes in their immunosuppressive maintenance medication. The basic treatment regimen in our patients consisted of an anticalcineurin agent, an antimetabolite, and a steroid.


OBJECTIVE
We undertook a descriptive study to quantify the incidence and causes of these changes and determine how they occur.


METHODS
We included the 432 HT performed at our center from November 1987 to October 2005. The baseline treatment was considered to be the treatment given following HT, and the maintenance treatment was that taken at the time of data collection. Kaplan-Meier survival curves were constructed for the analysis.


RESULTS
The most significant change was the switch from azathioprine to mycophenolate mofetil. The survival rate after 17 years was 66%.


CONCLUSIONS
As in the international registries, there has been an evident reduction in the use of cyclosporine and more particularly of azathioprine, in favor of tacrolimus and mycophenolate mofetil, respectively. No changes in the use of steroids have been observed. These data reflect an increasingly greater use of immunosuppressive agents with reduced side effect profiles.
Sánchez-Lázaro
I
I
Heart Failure and Transplantation Unit, Hospital Universitario La Fe, Valencia, Spain. igsanla@comv.es
Almenar
L
L
Martínez-Dolz
L
L
Chamorro
C
C
Moro
J
J
Agüero
J
J
Rueda
J
J
Zorio
E
E
Arnau
M A
MA
Salvador
A
A
D001379:Azathioprine / Q000627:therapeutic use; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D009173:Mycophenolic Acid / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine