Details

Autor(en) / Beteiligte

• Gonzalez-Vilchez, F
• Vazquez de Prada, J.A
• Paniagua, M.J
• Gomez-Bueno, M
• Arizon, J.M
• Almenar, L
• Roig, E
• Delgado, J
• Lambert, J.L
• Perez-Villa, F
• Sanz-Julve, M.L
• Crespo-Leiro, M
• Segovia, J
• Lopez-Granados, A
• Martinez-Dolz, L
• Mirabet, S
• Escribano, P
• Diaz-Molina, B
• Farrero, M
• Blasco, T

Titel

Use of mTOR inhibitors in chronic heart transplant recipients with renal failure: Calcineurin-inhibitors conversion or minimization?

Ist Teil von

• International journal of cardiology, 2014-01, Vol.171 (1), p.15-23

Ort / Verlag

Shannon: Elsevier Ireland Ltd

Erscheinungsjahr

2014

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Background In the last decade, mTOR inhibitors (mTOR-is) have become the cornerstone of the calcineurin inhibitor (CNI)-reduced/free regimens aimed to the preservation of post-transplant renal function. We compared utility and safety of the total replacement of calcineurin inhibitors with a mTOR-i with a strategy based on calcineurin inhibitor minimization and concomitant use of m-TOR-i. Methods In a retrospective multi-center cohort of 394 maintenance cardiac recipients with renal failure (GFR < 60 mL/min/1.73 m2 ), we compared 235 patients in whom CNI was replaced with a mTOR-i (sirolimus or everolimus) with 159 patients in whom mTOR-is were used to minimize CNIs. A propensity score analysis was carried out to balance between group differences. Results Overall, after a median time of 2 years from mTOR-i initiation, between group differences for the evolution of renal function were not observed. In a multivariate adjusted model, improvement of renal function was limited to patients with mTOR-i usage within 5 years after transplantation, particularly with the conversion strategy, and in those patients who could maintain mTOR-i therapy. Significant differences between strategies were not found for mortality, infection and mTOR-i withdrawal due to drug-related adverse events. However, conversion group tended to have a higher acute rejection incidence than the minimization group (p = 0.07). Conclusion In terms of renal benefits, our results support an earlier use of mTOR-is, irrespective of the strategy. The selection of either a conversion or a CNI minimization protocol should be based on the clinical characteristics of the patients, particularly their rejection risk.