title: Renal function improvement after conversion to proliferation signal inhibitors during long-term follow-up in heart transplant recipients.
abstract: BACKGROUND
  The use of proliferation signal inhibitors (PSIs) for calcineurin-inhibitor (CNI) minimization or conversion protocols has been promoted for heart transplantation (HT) in the contexts of renal insufficiency, cardiac allograft vasculopathy (CAV), or malignancy. We evaluated our experience with conversion of patients from a CNI-based to a PSI-based immunosuppressive regimen. We focused on improvement in renal function.
  
  
  METHODS
  This prospective follow-up included 96 HT patients converted to a PSI-based regimen from 2001 to 2010. We evaluated changes in creatinine clearance (CrCl) prior to at 1 year and at the end of follow-up after conversion.
  
  
  RESULTS
  Ninety-six patients including 86% men showed a mean age of 62 ± 8 years. They were converted to a PSI-based regimen at 6.3 ± 4 years post-HT due to the following causes: CNI toxicity (45%), CAV (16%), cancer (16%), CNI toxicity + CAV (17%), or CNI toxicity + cancer (6%). CNI withdrawal was achieved in 77 cases (80%) and minimization in 19 (20%). Everolimus was used in 54 (56%) and sirolimus in 42 (44%) cases. Median follow-up time was 3.8 years. PSI discontinuation due to side effects was common (38%). There were 43 deaths mainly due to cancer and CAV. CrCl improved albeit not significantly in the withdrawal group from a median of 51 mL/min preconversion to 59 mL/min at the last follow-up (P = .12). In the minimization group, median CrCl worsened from a median of 61 mL/min preconversion to 51 mL/min at the last follow-up (P = .001). In the 58 cases (61%) of CNI nephrotoxicity, median CrCl improved from a median of 41 mL/min preconversion to 49 mL/min at the last follow-up (P = .04).
  
  
  CONCLUSIONS
  Despite high rates of discontinuation of PSIs during long-term follow-up, the conversion regimen seemed to be useful to diminish CNI-related renal insufficiency especially with CNI withdrawal.
authors.affiliation: Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Kaplinsky
authors.forename: J
authors.initials: J
authors.lastname: González-Costello
authors.forename: N
authors.initials: N
authors.lastname: Manito
authors.forename: J
authors.initials: J
authors.lastname: Roca
authors.forename: M J
authors.initials: MJ
authors.lastname: Barbosa
authors.forename: M
authors.initials: M
authors.lastname: Nebot
authors.forename: J
authors.initials: J
authors.lastname: Salazar-Mendiguchia
authors.forename: J
authors.initials: J
authors.lastname: Berdejo
authors.forename: P
authors.initials: P
authors.lastname: Mañas
authors.forename: A
authors.initials: A
authors.lastname: Miralles
authors.forename: A
authors.initials: A
authors.lastname: Cequier
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D065095:Calcineurin Inhibitors; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D016027:Heart Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D015398:Signal Transduction / Q000187:drug effects*; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000068338:Everolimus; D003404:Creatinine; D020123:Sirolimus; D016559:Tacrolimus