title: Suppressive effects of conversion from mycophenolate mofetil to everolimus for the development of cardiac allograft vasculopathy in maintenance of heart transplant recipients.
abstract: BACKGROUND
  Whether converting to everolimus (EVL) from mycophenolate mofetil (MMF) during the maintenance period after heart transplantation (HTx) reduces cardiac allograft vasculopathy (CAV) progression remains unclear. We sought to determine the effect of converting from MMF with standard-dose calcineurin inhibitors (CNIs) to EVL with low-dose CNIs on CAV progression.
  
  
  METHODS
  We retrospectively reviewed the medical records of 63 HTx recipients who survived at least at 1 year after HTx. Twenty-four recipients were converted from MMF to EVL (EVL group, 2.2 ± 2.3 years after HTx), while 39 recipients were maintained on MMF (MMF group, 2.4 ± 2.2 years after HTx). The EVL group underwent three-dimensional intravascular ultrasound (3D-IVUS) analysis before and 1 year after conversion to EVL, and these data were compared with data from 2 consecutive IVUS in the MMF group.
  
  
  RESULTS
  IVUS indices in the EVL group at 1 year after conversion did not show increased CAV development, whereas a significant increase in %plaque volume (p=0.006) and decrease in lumen volume (p<0.001) were observed in the MMF group. EVL conversion was significantly associated with smaller increases in %plaque volume (p=0.004) and smaller decreases in lumen volume (p=0.017). IVUS indices in the late EVL conversion group (≥ 2 years) also did not exhibit increased CAV development, while those in the MMF group did.
  
  
  CONCLUSIONS
  Conversion to EVL from MMF in maintenance periods after HTx may decrease the rate of CAV progression based on IVUS indices.
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Seguchi
authors.affiliation: Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Cardiology, Kumiai Kosei Hospital, Takayama, Gifu, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Murata
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yanase
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Sunami
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Hisamatsu
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kuroda
authors.affiliation: Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Michinari
authors.initials: M
authors.lastname: Hieda
authors.affiliation: Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Wada
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hata
authors.affiliation: Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Hatsue
authors.initials: H
authors.lastname: Ishibashi-Ueda
authors.affiliation: Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Norihide
authors.initials: N
authors.lastname: Fukushima
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: nakatani.takeshi.hp@mail.ncvc.go.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000068338:Everolimus / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D021621:Imaging, Three-Dimensional / Q000379:methods; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D011183:Postoperative Complications; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D065095:Calcineurin Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; D009173:Mycophenolic Acid
keywords: Cardiac allograft vasculopathy; Everolimus; Heart transplantation; Three-dimensional intravascular ultrasound