Heart Transplantation Under Cyclosporine or Tacrolimus Combined With Mycophenolate Mofetil or Everolimus
Journal
Transplantation Proceedings
Journal Volume
40
Journal Issue
8
Pages
2607-2608
Date Issued
2008
Author(s)
Ko W.J.
Tsao C.I.
Sun C.D.
Abstract
Objective: In this study, we examined whether cyclosporine was effective when combined with everolimus in clinical heart transplantation (HT). Patients and Methods: From August 2004 to July 2007, 108 adult patients underwent primary HT. The main exclusion criteria were: donors >60 years; cold ischemia times >6 hours; recipients of multiorgan transplantation or a previous transplantation; and panel-reactive antibodies ?25%. The cyclosporine plus everolimus regimen (group CE, n = 32) was suggested first; upon refusal or if the recipient or donor was positive for hepatitis B surface antigen or PCR + hepatitis C infection, then patient was randomly assigned to success cyclosporine plus mycophenolate mofetil (MMF; group CM, n = 24) or tacrolimus plus MMF (group TM, n = 25). All patients underwent similar operative procedures and postoperative care with protocol endomyocardial biopsies. Results: No 30-day mortality was noted in any group. The efficacy failure rates were 3%, 25%, and 16% in groups CE, CM, and TM, respectively (P = .04 between groups CE and CM). The 1-year survivals were 96.7% ± 18.1%, 89.7% ± 29.8%, and 81.0% ± 35.5% for groups CE, CM, and TM, respectively (P = .04 between groups CE and TM). The 3-year survival rates were 91.9% ± 28.3%, 79.8% ± 46.0%, and 81.0% ± 35.5% in groups CE, CM, and TM, respectively. Conclusions: The 3 immunosuppressive regimens offered good efficacy after HT. The cyclosporine plus everolimus regimen showed a significantly better result with less efficacy failure (compared with cyclosporine plus MMF: 3% vs 25%) and better 1-year survival compared with tacrolimus plus MMF: 96.7% vs 81.0%. ? 2008 Elsevier Inc. All rights reserved.
SDGs
Other Subjects
antibody; cyclosporin; everolimus; hepatitis B surface antigen; mycophenolic acid 2 morpholinoethyl ester; tacrolimus; adult; article; cardiac graft rejection; clinical trial; cold ischemia; controlled clinical trial; controlled study; drug efficacy; female; heart muscle biopsy; heart transplantation; hepatitis C; human; immunosuppressive treatment; major clinical study; male; mortality; organ donor; organ transplantation; polymerase chain reaction; postoperative care; priority journal; randomized controlled trial; recipient; survival rate; therapy; treatment failure; virus infection; Adult; Cardiomyopathy, Dilated; Cyclosporine; Drug Therapy, Combination; Female; Graft Rejection; Heart Transplantation; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Myocardial Ischemia; Patient Selection; Sirolimus; Survival Analysis; Survivors; Tacrolimus; Tissue Donors; Treatment Outcome
Type
journal article