Rejection after conversion to a proliferation signal inhibitor in chronic heart transplantation
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd..
We sought to determine the incidence, risk factors, and consequences of acute rejection (AR) after conversion from a calcineurin inhibitor (CNI) to a proliferation signal inhibitor (PSI) in maintenance heart transplantation. Relevant clinical data were retrospectively obtained for 284 long-term heart transplant recipients from nine centers in whom CNIs were replaced with a PSI (sirolimus or everolimus) between October 2001 and March 2009. The rejection rate at one yr was 8.3%, stabilizing to 2% per year thereafter. The incidence rate after conversion (4.9 per 100 patient-years) was significantly higher than that observed on CNI therapy in the pre-conversion period (2.2 per 100 patient-years). By multivariate analysis, rejection risk was associated with a history of late AR prior to PSI conversion, early conversion (<5 yr) after transplantation and age <50 yr at the time of conversion. Use of mycophenolate mofetil was a protective factor. Post-conversion rejection did not significantly influence the evolution of left ventricular ejection fraction, renal function, or mortality during further follow-up. Conversion to a CNI-free immunosuppression based on a PSI results in an increased risk of AR. Awareness of the clinical determinants of post-conversion rejection could help to refine the current PSI conversion strategies.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2013 |
---|---|
Erschienen: |
2013 |
Enthalten in: |
Zur Gesamtaufnahme - volume:27 |
---|---|
Enthalten in: |
Clinical transplantation - 27(2013), 6 vom: 04. Nov., Seite E649-58 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
González-Vílchez, Francisco [VerfasserIn] |
---|
Links: |
---|
Anmerkungen: |
Date Completed 14.08.2014 Date Revised 19.11.2015 published: Print-Electronic Citation Status MEDLINE |
---|
doi: |
10.1111/ctr.12241 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM230764053 |
---|
LEADER | 01000naa a22002652 4500 | ||
---|---|---|---|
001 | NLM230764053 | ||
003 | DE-627 | ||
005 | 20231224085157.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231224s2013 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1111/ctr.12241 |2 doi | |
028 | 5 | 2 | |a pubmed24n0769.xml |
035 | |a (DE-627)NLM230764053 | ||
035 | |a (NLM)24025040 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a González-Vílchez, Francisco |e verfasserin |4 aut | |
245 | 1 | 0 | |a Rejection after conversion to a proliferation signal inhibitor in chronic heart transplantation |
264 | 1 | |c 2013 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 14.08.2014 | ||
500 | |a Date Revised 19.11.2015 | ||
500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. | ||
520 | |a We sought to determine the incidence, risk factors, and consequences of acute rejection (AR) after conversion from a calcineurin inhibitor (CNI) to a proliferation signal inhibitor (PSI) in maintenance heart transplantation. Relevant clinical data were retrospectively obtained for 284 long-term heart transplant recipients from nine centers in whom CNIs were replaced with a PSI (sirolimus or everolimus) between October 2001 and March 2009. The rejection rate at one yr was 8.3%, stabilizing to 2% per year thereafter. The incidence rate after conversion (4.9 per 100 patient-years) was significantly higher than that observed on CNI therapy in the pre-conversion period (2.2 per 100 patient-years). By multivariate analysis, rejection risk was associated with a history of late AR prior to PSI conversion, early conversion (<5 yr) after transplantation and age <50 yr at the time of conversion. Use of mycophenolate mofetil was a protective factor. Post-conversion rejection did not significantly influence the evolution of left ventricular ejection fraction, renal function, or mortality during further follow-up. Conversion to a CNI-free immunosuppression based on a PSI results in an increased risk of AR. Awareness of the clinical determinants of post-conversion rejection could help to refine the current PSI conversion strategies | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Multicenter Study | |
650 | 4 | |a Research Support, Non-U.S. Gov't | |
650 | 4 | |a cardiac transplantation | |
650 | 4 | |a complications | |
650 | 4 | |a everolimus | |
650 | 4 | |a rejection | |
650 | 4 | |a sirolimus | |
650 | 7 | |a Calcineurin Inhibitors |2 NLM | |
650 | 7 | |a Immunosuppressive Agents |2 NLM | |
650 | 7 | |a Everolimus |2 NLM | |
650 | 7 | |a 9HW64Q8G6G |2 NLM | |
650 | 7 | |a Sirolimus |2 NLM | |
650 | 7 | |a W36ZG6FT64 |2 NLM | |
700 | 1 | |a Vázquez de Prada, José A |e verfasserin |4 aut | |
700 | 1 | |a Paniagua, María J |e verfasserin |4 aut | |
700 | 1 | |a Almenar, Luis |e verfasserin |4 aut | |
700 | 1 | |a Mirabet, Sonia |e verfasserin |4 aut | |
700 | 1 | |a Gómez-Bueno, Manuel |e verfasserin |4 aut | |
700 | 1 | |a Díaz-Molina, Beatriz |e verfasserin |4 aut | |
700 | 1 | |a Arizón, Jose M |e verfasserin |4 aut | |
700 | 1 | |a Delgado, Juan |e verfasserin |4 aut | |
700 | 1 | |a Pérez-Villa, Félix |e verfasserin |4 aut | |
700 | 1 | |a Crespo-Leiro, María G |e verfasserin |4 aut | |
700 | 1 | |a Martínez-Dolz, Luis |e verfasserin |4 aut | |
700 | 1 | |a Roig, Eulalia |e verfasserin |4 aut | |
700 | 1 | |a Segovia, Javier |e verfasserin |4 aut | |
700 | 1 | |a Lambert, José L |e verfasserin |4 aut | |
700 | 1 | |a Lopez-Granados, Amador |e verfasserin |4 aut | |
700 | 1 | |a Escribano, Pilar |e verfasserin |4 aut | |
700 | 1 | |a Farrero, Marta |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t Clinical transplantation |d 1987 |g 27(2013), 6 vom: 04. Nov., Seite E649-58 |w (DE-627)NLM07493306X |x 1399-0012 |7 nnns |
773 | 1 | 8 | |g volume:27 |g year:2013 |g number:6 |g day:04 |g month:11 |g pages:E649-58 |
856 | 4 | 0 | |u http://dx.doi.org/10.1111/ctr.12241 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 27 |j 2013 |e 6 |b 04 |c 11 |h E649-58 |