Tacrolimus monotherapy in adult cardiac transplant recipients: Intermediate-term results

David A. Baran, Leal Segura, Sudhir Kushwaha, Mary Courtney, Rhodora Correa, John T. Fallon, Judy Cheng, Steven L. Lansman, Alan L. Gass

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: Tacrolimus (FK506) is a macrolide antibiotic that inhibits T-cell activation and proliferation. To date, all published trials have used tacrolimus and steroids in combination with either azathioprine or mycophenolate mofetil. Previous experience with pediatric cardiac transplant patients at our institution suggested that use of tacrolimus alone provides an adequate level of immunosuppression and that withdrawal of steroids is readily achieved in most recipients. Methods - Between January 1, 1996, and July 7, 1999, we performed 77 adult cardiac transplants. Forty-three of these patients received tacrolimus and prednisone as primary immunosuppression, without azathioprine or mycophenolate mofetil. Thirty-two of the 43 patients started on tacrolimus have been weaned off steroids and are maintained on monotherapy. These latter patients form the basis of this report. Results - The mean time for achieving monotherapy was 246 ± 127 days (range, 106 to 730). Grade ≥ 2 rejection occurred at 0.40 episodes per patient in the first 90 days (a combination of Grades 2 and 3A/3B rejections). The freedom from treated rejection (includes all 3A/3B and Grade 2 rejection in the first 90 days) was 69% at 90 days and 52% at 1 year. One patient (of 32) had documented cytomegalovirus infection (gastritis) diagnosed at 8 months post-transplant. We observed 1 case of transplant vasculopathy and 1 case of post-transplant lymphoproliferative disorder during the follow-up period. Conclusions - Our results show that use of tacrolimus alone after steroid weaning provides effective immunosuppression with low incidence of rejection, cytomegalovirus infection, transplant arteriopathy, or post-transplant lymphoproliferative disease.

Original languageEnglish (US)
Pages (from-to)59-70
Number of pages12
JournalJournal of Heart and Lung Transplantation
Volume20
Issue number1
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Tacrolimus
Transplants
Steroids
Immunosuppression
Mycophenolic Acid
Azathioprine
Cytomegalovirus Infections
Lymphoproliferative Disorders
Macrolides
Gastritis
Prednisone
Transplant Recipients
Weaning
Cell Proliferation
Pediatrics
Anti-Bacterial Agents
T-Lymphocytes
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Baran, D. A., Segura, L., Kushwaha, S., Courtney, M., Correa, R., Fallon, J. T., ... Gass, A. L. (2001). Tacrolimus monotherapy in adult cardiac transplant recipients: Intermediate-term results. Journal of Heart and Lung Transplantation, 20(1), 59-70. https://doi.org/10.1016/S1053-2498(00)00237-0

Tacrolimus monotherapy in adult cardiac transplant recipients : Intermediate-term results. / Baran, David A.; Segura, Leal; Kushwaha, Sudhir; Courtney, Mary; Correa, Rhodora; Fallon, John T.; Cheng, Judy; Lansman, Steven L.; Gass, Alan L.

In: Journal of Heart and Lung Transplantation, Vol. 20, No. 1, 2001, p. 59-70.

Research output: Contribution to journalArticle

Baran, DA, Segura, L, Kushwaha, S, Courtney, M, Correa, R, Fallon, JT, Cheng, J, Lansman, SL & Gass, AL 2001, 'Tacrolimus monotherapy in adult cardiac transplant recipients: Intermediate-term results', Journal of Heart and Lung Transplantation, vol. 20, no. 1, pp. 59-70. https://doi.org/10.1016/S1053-2498(00)00237-0
Baran, David A. ; Segura, Leal ; Kushwaha, Sudhir ; Courtney, Mary ; Correa, Rhodora ; Fallon, John T. ; Cheng, Judy ; Lansman, Steven L. ; Gass, Alan L. / Tacrolimus monotherapy in adult cardiac transplant recipients : Intermediate-term results. In: Journal of Heart and Lung Transplantation. 2001 ; Vol. 20, No. 1. pp. 59-70.
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abstract = "Background: Tacrolimus (FK506) is a macrolide antibiotic that inhibits T-cell activation and proliferation. To date, all published trials have used tacrolimus and steroids in combination with either azathioprine or mycophenolate mofetil. Previous experience with pediatric cardiac transplant patients at our institution suggested that use of tacrolimus alone provides an adequate level of immunosuppression and that withdrawal of steroids is readily achieved in most recipients. Methods - Between January 1, 1996, and July 7, 1999, we performed 77 adult cardiac transplants. Forty-three of these patients received tacrolimus and prednisone as primary immunosuppression, without azathioprine or mycophenolate mofetil. Thirty-two of the 43 patients started on tacrolimus have been weaned off steroids and are maintained on monotherapy. These latter patients form the basis of this report. Results - The mean time for achieving monotherapy was 246 ± 127 days (range, 106 to 730). Grade ≥ 2 rejection occurred at 0.40 episodes per patient in the first 90 days (a combination of Grades 2 and 3A/3B rejections). The freedom from treated rejection (includes all 3A/3B and Grade 2 rejection in the first 90 days) was 69{\%} at 90 days and 52{\%} at 1 year. One patient (of 32) had documented cytomegalovirus infection (gastritis) diagnosed at 8 months post-transplant. We observed 1 case of transplant vasculopathy and 1 case of post-transplant lymphoproliferative disorder during the follow-up period. Conclusions - Our results show that use of tacrolimus alone after steroid weaning provides effective immunosuppression with low incidence of rejection, cytomegalovirus infection, transplant arteriopathy, or post-transplant lymphoproliferative disease.",
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AU - Correa, Rhodora

AU - Fallon, John T.

AU - Cheng, Judy

AU - Lansman, Steven L.

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N2 - Background: Tacrolimus (FK506) is a macrolide antibiotic that inhibits T-cell activation and proliferation. To date, all published trials have used tacrolimus and steroids in combination with either azathioprine or mycophenolate mofetil. Previous experience with pediatric cardiac transplant patients at our institution suggested that use of tacrolimus alone provides an adequate level of immunosuppression and that withdrawal of steroids is readily achieved in most recipients. Methods - Between January 1, 1996, and July 7, 1999, we performed 77 adult cardiac transplants. Forty-three of these patients received tacrolimus and prednisone as primary immunosuppression, without azathioprine or mycophenolate mofetil. Thirty-two of the 43 patients started on tacrolimus have been weaned off steroids and are maintained on monotherapy. These latter patients form the basis of this report. Results - The mean time for achieving monotherapy was 246 ± 127 days (range, 106 to 730). Grade ≥ 2 rejection occurred at 0.40 episodes per patient in the first 90 days (a combination of Grades 2 and 3A/3B rejections). The freedom from treated rejection (includes all 3A/3B and Grade 2 rejection in the first 90 days) was 69% at 90 days and 52% at 1 year. One patient (of 32) had documented cytomegalovirus infection (gastritis) diagnosed at 8 months post-transplant. We observed 1 case of transplant vasculopathy and 1 case of post-transplant lymphoproliferative disorder during the follow-up period. Conclusions - Our results show that use of tacrolimus alone after steroid weaning provides effective immunosuppression with low incidence of rejection, cytomegalovirus infection, transplant arteriopathy, or post-transplant lymphoproliferative disease.

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