title: Prospective study of everolimus with calcineurin inhibitor-free immunosuppression in maintenance heart transplant patients: results at 2 years.
abstract: BACKGROUND
  Few studies have examined everolimus therapy with calcineurin inhibitor (CNI) withdrawal in maintenance heart transplant patients.
  
  
  METHODS
  In a prospective, single-arm, single-center study, CNI-treated heart transplant patients were converted to everolimus and were followed up for 24 months. The primary endpoints were kidney function and arterial hypertension at 12 and 24 months after conversion.
  
  
  RESULTS
  Fifty-eight patients were recruited (mean time posttransplant 5.6±3.7 years), 55 of whom (91.7%) had renal impairment. Mean creatinine clearance increased from 43.6±21.1 mL/min to 49.5±21.2 mL/min at month 24 (P=0.02). Median blood pressure increased from 120/80 mm Hg at baseline to 122.5/80 mm Hg (P=0.008 and 0.006 for systolic and diastolic pressure, respectively). Lipid parameters did not change significantly over the 24-month follow-up. Early resolution of most non-renal CNI-related adverse events was sustained. CNI therapy was re-introduced at a mean of 309 days (range, 31-684 days) in eight patients after month 6 due to adverse events (n=13) or withdrawal of consent (n=2). No significant changes in cardiac function parameters were observed.
  
  
  CONCLUSIONS
  CNI-free immunosuppression with everolimus is an effective and safe option in selected heart transplant maintenance patients. Most adverse effects under everolimus occurred early after conversion and generally resolved without intervention within a few weeks. Refining selection criteria may reduce the need to re-introduce CNI therapy.
authors.affiliation: Department of Cardiology and Angiology, University Hospital Muenster, Münster, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Engelen
authors.forename: Susanne
authors.initials: S
authors.lastname: Amler
authors.forename: Henryk
authors.initials: H
authors.lastname: Welp
authors.forename: Christian
authors.initials: C
authors.lastname: Vahlhaus
authors.forename: Stefan
authors.initials: S
authors.lastname: Gunia
authors.forename: Juergen R
authors.initials: JR
authors.lastname: Sindermann
authors.forename: Markus
authors.initials: M
authors.lastname: Rothenburger
authors.forename: Joerg
authors.initials: J
authors.lastname: Stypmann
mesh_terms: D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D057915:Drug Substitution; D000068338:Everolimus; D005858:Germany; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D007674:Kidney Diseases / Q000139:chemically induced / Q000503:physiopathology / Q000628:therapy; D008055:Lipids / Q000097:blood; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D008055:Lipids; D016572:Cyclosporine; D000068338:Everolimus; D003404:Creatinine; D020123:Sirolimus