Clinical experience of tacrolimus with everolimus in heart transplantation
Journal
Transplantation Proceedings
Journal Volume
44
Journal Issue
4
Pages
907-909
Date Issued
2012
Author(s)
Abstract
Background: Tacrolimus (Tac) in combination with mycophenolate mofetil is widely used after heart transplantation (HT). Everolimus (EVR), a new potent proliferation signal inhibitor can be used with a carcineurin inhibitor to reduce the occurrence of rejection. The purpose of this study was to evaluate the efficacy and safety of Tac combined with EVR in de novo HT. Materials and methods: From January 2009 to April 2011, 33/62 patients who underwent HT were prescribed Tac and EVR as de novo immunosuppression. The main exclusion criteria were poor kidney function (serum creatinine > 2.8 mg/dL), panel-reactive antibodies > 25%, donors > 60 years old, or cold ischemia time > 6 hours. All patients received Tac (C0 blood level 5-10 ng/mL during the first 6 months, then 3-5 ng/mL), EVR (C0 target 3-8 ng/mL), and corticosteroids. After transplantation, routine examinations included echocardiogram and protocol endomyocardial biopsy. Results: There was no operative mortality. The 1- and 3-year actuarial survivals were 95.74% ± 3.49%. One patient who had undergone coronary artery bypass grafting previously and received intra-aortic balloon pumping and extracorporeal membrane oxygenator-assisted cardiopulmonary resuscitation before HT died of Aspergillus septicemia 58 days after HT. No biopsy-proven acute rejection > grade 2R or acute rejection associated with hemodynamic compromise was observed. Hyperlipemia was noted in 16 cases (48.5%), hypertension in 11 (33.3% 5%), and diabetes mellitus in 12 (36.4%). No other severe adverse events were noted. Conclusions: Concentration-controlled EVR (C0 target 3-8 ng/mL) in combination with Tac achieved good efficacy and safety. The 1- and 3-year actuarial survivals were 95.74% ± 3.49%. ? 2012 Elsevier Inc.
SDGs
Other Subjects
corticosteroid; creatinine; everolimus; panel reactive antibody; tacrolimus; adult; aged; aorta balloon; cardiac graft rejection; clinical article; cold ischemia; conference paper; controlled study; coronary artery bypass graft; creatinine blood level; diabetes mellitus; drug efficacy; drug safety; echocardiography; extracorporeal oxygenation; female; heart hemodynamics; heart muscle biopsy; heart transplantation; human; hyperlipidemia; hypertension; immune deficiency; kidney function; living donor; male; post treatment survival; priority journal; resuscitation; septicemia; surgical mortality; Adolescent; Adult; Aged; Child; Diabetes Mellitus; Drug Therapy, Combination; Female; Graft Rejection; Graft Survival; Heart Transplantation; Humans; Hyperlipidemias; Hypertension; Immunosuppressive Agents; Male; Middle Aged; Prospective Studies; Sirolimus; Survival Analysis; Tacrolimus; Taiwan; Time Factors; Treatment Outcome; Young Adult
Type
conference paper