Conversion to sirolimus as primary immunosuppression attenuates the progression of allograft vasculopathy after cardiac transplantation

Eugenia Raichlin, Jang Ho Bae, Zain Khalpey, Brooks S. Edwards, Walter K. Kremers, Alfredo L. Clavell, Richard J. Rodeheffer, Robert P. Frantz, Charanjit Rihal, Amir Lerman, Sudhir S. Kushwaha

Research output: Contribution to journalArticle

133 Scopus citations

Abstract

BACKGROUND: We investigated the potential of conversion to sirolimus (SRL) as a primary immunosuppressant in attenuating cardiac allograft vasculopathy progression. METHODS AND RESULTS: Twenty-nine cardiac transplant recipients were converted to SRL 3.8±3.4 years after transplantation with complete calcineurin inhibitor (CNI) withdrawal. Secondary immunosuppressants (azathioprine or mycophenolate) and steroids remained unchanged. Forty patients (controls) 4.8±4.0 years from transplantation were maintained on CNIs. Three-dimensional intravascular ultrasound studies were performed at baseline and 12.1±2.6 months later. Mean plaque (media and intima) volume (PV) and plaque index (PI) (PV/vessel volume percent) increased significantly in the CNI group (1.28±2.86 mm/mm, P=0.004; and 6±8%, P=0.0001) but not in the SRL group (0.1±1.13 mm/mm, P=0.63; and 0.1±8%, P=0.94). In patients enrolled within 2 years after transplantation, the increases in PV (0.06±1.06 versus 1.77±1.65 mm/mm; P=0.0081) and PI (0±9% versus 10±8%; P=0.0145) were smaller in the SRL group (n=11) than in the CNI (n=12) group. In patients enrolled ≥2 years after transplantation, the increase in PI was less in the SRL group compared with the CNI group (0.1±6.5% versus 5±8%; P=0.033), but changes in PV did not differ significantly. Treatment with azathioprine or mycophenolate did not affect PV or PI in either the SRL group (PV: 0.22±0.66 versus 0.05±1.45 mm/mm, P=0.46; PI: 1.5±6% versus -1.6±8.5%, P=0.29) or the CNI group (PV: 1.42±1.39 versus 1.06±2.28 mm/mm, P=0.49; PI: 7.8±8.7% versus 4.8±7.3%, P=0.23). CONCLUSIONS: Substituting CNI with SRL as primary immunosuppression attenuates cardiac allograft vasculopathy progression.

Original languageEnglish (US)
Pages (from-to)2726-2733
Number of pages8
JournalCirculation
Volume116
Issue number23
DOIs
StatePublished - Dec 1 2007

Keywords

  • Coronary disease
  • Immune system
  • Transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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