Efficacy of tacrolimus in patients with steroid-resistant cardiac allograft cellular rejection

Mohamad H. Yamani, Randall C. Starling, David Pelegrin, Luba Platt, Mark Majercik, Robert E. Hobbs, Patrick McCarthy, James B. Young

Research output: Contribution to journalArticle

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Abstract

Background: Tacrolimus is an immunosuppressive agent that is gaining widespread use in solid organ transplantation. This study was undertaken to evaluate the efficacy of tacrolimus in treating steroid-resistant cellular myocardial rejection. Methods: We retrospectively analyzed the incidence of rejection and clinical outcome of 21 heart transplant recipients who were electively converted from cyclosporine to tacrolimus for recurrent episodes of steroid-resistant cellular rejection. These were compared to a historic group of 6 hemodynamically stable patients who were treated electively with Orthoclone OKT3 (Muromonab/CD3) for recurrent rejection. Results: Eighty five percent (56/66) of the episodes of rejection occurred within the first 3 months after heart transplantation. Tacrolimus was started 2.4 ± 2.0 months post-transplant, and the mean follow-up duration on tacrolimus was 11.0 ± 7.0 months. After conversion, a significant decline was noted in both the number of episodes of acute rejection per patient (3.14 ± 0.85-0.57 ± 0.87, p < 0.0001), and the incidence of acute rejection per 100 patient-days (6.39 ± 3.96-0.25 ± 0.47, p < 0.0001). In comparison, OKT3 was started 5.25 ± 9.20 months post-transplant. Similarly, there was a significant decrease in the incidence of acute rejection per 100 patient-days (8.69 ± 5.65-0.20 ± 0.23, p < 0.0001). The average hospital charges per patient for the OKT3-treated group was $33,339 ± $10,511. There was no significant difference in the actuarial 1-year survival between the tacrolimus and OKT3-treated groups (93% vs 80%, p = 0.5). Conclusions: Outpatient conversion to tacrolimus is safe, well tolerated, and an effective therapeutic strategy for the treatment of steroid-resistant cellular rejection in heart transplant recipients. It is more cost-effective than OKT3 in the hemodynamically stable patient and outcomes are similar.

Original languageEnglish (US)
Pages (from-to)337-342
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume19
Issue number4
DOIs
StatePublished - 2000
Externally publishedYes

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Muromonab-CD3
Tacrolimus
Allografts
Steroids
Incidence
Hospital Charges
Transplants
Organ Transplantation
Heart Transplantation
Immunosuppressive Agents
Cyclosporine
Outpatients
Costs and Cost Analysis
Survival
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Yamani, M. H., Starling, R. C., Pelegrin, D., Platt, L., Majercik, M., Hobbs, R. E., ... Young, J. B. (2000). Efficacy of tacrolimus in patients with steroid-resistant cardiac allograft cellular rejection. Journal of Heart and Lung Transplantation, 19(4), 337-342. https://doi.org/10.1016/S1053-2498(00)00059-0

Efficacy of tacrolimus in patients with steroid-resistant cardiac allograft cellular rejection. / Yamani, Mohamad H.; Starling, Randall C.; Pelegrin, David; Platt, Luba; Majercik, Mark; Hobbs, Robert E.; McCarthy, Patrick; Young, James B.

In: Journal of Heart and Lung Transplantation, Vol. 19, No. 4, 2000, p. 337-342.

Research output: Contribution to journalArticle

Yamani, MH, Starling, RC, Pelegrin, D, Platt, L, Majercik, M, Hobbs, RE, McCarthy, P & Young, JB 2000, 'Efficacy of tacrolimus in patients with steroid-resistant cardiac allograft cellular rejection', Journal of Heart and Lung Transplantation, vol. 19, no. 4, pp. 337-342. https://doi.org/10.1016/S1053-2498(00)00059-0
Yamani, Mohamad H. ; Starling, Randall C. ; Pelegrin, David ; Platt, Luba ; Majercik, Mark ; Hobbs, Robert E. ; McCarthy, Patrick ; Young, James B. / Efficacy of tacrolimus in patients with steroid-resistant cardiac allograft cellular rejection. In: Journal of Heart and Lung Transplantation. 2000 ; Vol. 19, No. 4. pp. 337-342.
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abstract = "Background: Tacrolimus is an immunosuppressive agent that is gaining widespread use in solid organ transplantation. This study was undertaken to evaluate the efficacy of tacrolimus in treating steroid-resistant cellular myocardial rejection. Methods: We retrospectively analyzed the incidence of rejection and clinical outcome of 21 heart transplant recipients who were electively converted from cyclosporine to tacrolimus for recurrent episodes of steroid-resistant cellular rejection. These were compared to a historic group of 6 hemodynamically stable patients who were treated electively with Orthoclone OKT3 (Muromonab/CD3) for recurrent rejection. Results: Eighty five percent (56/66) of the episodes of rejection occurred within the first 3 months after heart transplantation. Tacrolimus was started 2.4 ± 2.0 months post-transplant, and the mean follow-up duration on tacrolimus was 11.0 ± 7.0 months. After conversion, a significant decline was noted in both the number of episodes of acute rejection per patient (3.14 ± 0.85-0.57 ± 0.87, p < 0.0001), and the incidence of acute rejection per 100 patient-days (6.39 ± 3.96-0.25 ± 0.47, p < 0.0001). In comparison, OKT3 was started 5.25 ± 9.20 months post-transplant. Similarly, there was a significant decrease in the incidence of acute rejection per 100 patient-days (8.69 ± 5.65-0.20 ± 0.23, p < 0.0001). The average hospital charges per patient for the OKT3-treated group was $33,339 ± $10,511. There was no significant difference in the actuarial 1-year survival between the tacrolimus and OKT3-treated groups (93{\%} vs 80{\%}, p = 0.5). Conclusions: Outpatient conversion to tacrolimus is safe, well tolerated, and an effective therapeutic strategy for the treatment of steroid-resistant cellular rejection in heart transplant recipients. It is more cost-effective than OKT3 in the hemodynamically stable patient and outcomes are similar.",
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AU - McCarthy, Patrick

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