Discontinuation of calcineurin inhibitors in heart transplant patients with end stage renal insufficiency as an alternative model of immunosuppression.
Five heart recipients were followed up with mycophenolate mofetil and low dose cyclosporine due to progressive severe chronic postcyclosporine renal failure. Cyclosporine was gradually withdrawn and finally eliminated from immunosuppressive regimen to slow the rate of renal function loss. Improvement of renal function was observed. In the follow up after cyclosporine elimination no risk increase of acute rejection and no deterioration of left ventricle function was observed. Non-calcineurin inhibitors model in heart recipients can be the treatment of choice (but only in very selective cases) in patients with severe chronic renal insufficiency.
Jerzy
Sadowski
S
Department of Cardiovascular and Transplantation Surgery, Institute of Cardiology, Jagiellonian University, Krakow, Poland. kardiochir@szpitaljp2.krakow.pl
Wierzbicki
Karol
K
Kapelak
Bogusław
B
Konstanty
Janusz
J
Przybyłowski
Piotr
P
Wójcik
Sławomir
S
Drwiła
Rafał
R
Wróbel
Krzysztof
K
Piatek
Jacek
J
D000328:Adult; D000368:Aged; D019703:Calcineurin / Q000378:metabolism; D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D019703:Calcineurin; D009173:Mycophenolic Acid