title: Calcineurin inhibitor- and corticosteroid-free immunosuppression in pediatric heart transplant patients.
abstract: Pediatric heart transplant patients at our institution are immunosuppressed with a CNI and another immune-modulating agent without utilizing corticosteroids. Patients whose renal function worsened and who did not respond to CNI minimization had their CNI discontinued. The clinical history of 35 pediatric heart transplant patients with significant renal insufficiency whose CNI was discontinued was retrospectively analyzed. Data including serum creatinine and weight were collected before, at time of, and every 3-6 months after CNI discontinuation. This was used to calculate an eGFR. Cardiac allograft rejection and mortality data were also collected. CNI discontinuation occurred 39 times in 35 patients. The median eGFR significantly increased by 14 mL/min 3 months after CNI discontinuation and the increase continued to be significant (P≤.05) at 5 years. Freedom from rejection analysis showed no difference between graft rejection 2 years before versus after CNI discontinuation (P=.437). No mortality was associated with CNI discontinuation. Immunosuppression free of CNIs and corticosteroids appears to be a safe alternative in pediatric heart transplant patients with significant renal insufficiency. Furthermore, this strategy can significantly reverse renal insufficiency, even late after transplantation.
authors.affiliation: School of Pharmacy, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Sierra
authors.affiliation: Medical Center, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Tan
authors.affiliation: Children's Hospital, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Eguchi
authors.affiliation: School of Medicine, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Bailey
authors.affiliation: Children's Hospital, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Chinnock
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D065095:Calcineurin Inhibitors / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006333:Heart Failure / Q000276:immunology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007108:Immune Tolerance; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000187:drug effects / Q000502:physiology; D008297:Male; D051437:Renal Insufficiency / Q000188:drug therapy; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents
keywords: calcineurin inhibitors; glomerular filtration rate; immunosuppression; pediatric heart transplant; renal insufficiency; steroid-free immunosuppression