title: Outcomes following de novo CNI-free immunosuppression after heart transplantation: a single-center experience.
abstract: Renal impairment at the time of heart transplantation complicates the choice of subsequent immunosuppressive therapy. Calcineurin (CNI)-free regimens utilizing proliferation signal inhibitors (PSI) may mitigate against nephrotoxicity in this group; however, their effectiveness remains unclear. We present our 7-year experience with de novo CNI-free, PSI-based immunosuppression after heart transplantation. Of the 152 patients transplanted between July 1999 and July 2006, de novo immunosuppression regimens were 49 CNI-free, PSI-based, 88 CNI, 15 combination of CNI+PSI. Pretransplant creatinine clearance improved within 6 months in the PSI group (0.69 +/- 0.34 mL/s vs. 1.00 +/- 0.54 mL/s, p < 0.05) but not the CNI (1.32 +/- 0.54 mL/s vs. 1.36 +/- 0.53 mL/s, p = ns) or CNI+PSI (1.20 +/- 0.24 mL/s vs. 1.20 +/- 0.41 mL/s, p = ns) groups. The PSI group had more episodes of early (<or=6 months) acute rejection, bacterial or fungal infections and pleural effusions but less CMV infection (p < 0.05 for all comparisons). Early CNI addition occurred in 37% of the PSI group for acute rejection. 33% of the entire cohort changed immunosuppression regimens over 3.6 +/- 2.2 years follow-up. De novo CNI-free, PSI-based immunosuppression in patients with significant renal dysfunction allowed significant posttransplantation renal recovery but with increased early acute rejection, bacterial and fungal infections and pleural effusions.
authors.affiliation: Department of Cardiology, The Alfred Hospital, Melbourne, Australia. a.leet@alfred.org.au
authors.forename: A S
authors.initials: AS
authors.lastname: Leet
authors.forename: P J
authors.initials: PJ
authors.lastname: Bergin
authors.forename: M
authors.initials: M
authors.lastname: Richardson
authors.forename: A J
authors.initials: AJ
authors.lastname: Taylor
authors.forename: D
authors.initials: D
authors.lastname: Esmore
authors.forename: D M
authors.initials: DM
authors.lastname: Kaye
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy; D003404:Creatinine / Q000652:urine; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine