title: Influence of immunosuppressive regimens on short-term morbidity and mortality in heart transplantation.
abstract: BACKGROUND
  The goal of immunosuppressive therapy in heart transplantation is to maximize safety and efficacy while minimizing morbidity and mortality. We now have numerous drug combinations, but few have been compared with each other.
  
  
  OBJECTIVE
  To compare various immunosuppressive regimens assessing morbidity and mortality at one yr.
  
  
  METHODS
  A total of 351 patients transplanted between 1989 and 2005 were included and grouped by immunosuppressive regimen into group 1 (n = 52): Muronomab (OKT3) 10 d, cyclosporine (CSA), azathioprine (AZA), steroids; group 2 (n = 193): OKT3 seven d, CSA, AZA, steroids; group 3 (n = 22): OKT3 seven d, CSA, mycophenolate mofetil (MMF), steroids; and group 4 (n = 84): interleukin-2 antagonists (IL-2), CSA, MMF, steroids.
  
  
  RESULTS
  The incidence of acute graft failure and treated rejection was similar between groups (17% and 78% respectively). We found a statistically significant difference in the incidence of infections (p < 0.001), renal dysfunction (p = 0.011) and in diabetes mellitus (p = 0.023). There were no differences in survival at 30 d (97%), but differences were found at one yr (p = 0.011). The multivariate analysis showed a strong association between mortality and infection (p = 0.001) and between survival and the group 4 regimen (p < 0.001).
  
  
  CONCLUSIONS
  There are differences in survival at one yr of heart transplant patients depending on the immunosuppressive regimen used. The best combination was induction with IL-2 antagonists, followed by CSA, MMF and steroids.
authors.affiliation: Heart Failure and Transplant Unit, Cardiology Department, La Fe University Hospital, Valencia, Spain. jaimeaguero30@hotmail.com
authors.forename: Jaime
authors.initials: J
authors.lastname: Aguero
authors.forename: Luis
authors.initials: L
authors.lastname: Almenar
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Dolz
authors.forename: Jose A
authors.initials: JA
authors.lastname: Moro
authors.forename: Joaquin
authors.initials: J
authors.lastname: Rueda
authors.forename: Rafael
authors.initials: R
authors.lastname: Raso
authors.forename: Carlos
authors.initials: C
authors.lastname: Chamorro
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sanchez
authors.forename: Antonio
authors.initials: A
authors.lastname: Salvador
mesh_terms: D000328:Adult; D002423:Cause of Death; D015897:Comorbidity; D016572:Cyclosporine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D011183:Postoperative Complications / Q000517:prevention & control; D016019:Survival Analysis; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid