Lubitz SA, Baran DA, Alwarshetty MM, Pinney S, Kaplan S, Chan M,
Courtney MC, Lansman SL, Spielvogel D, Gass AL.Long-term
Results of FK506 Monotherapy in Cardiac Transplant Recipients
J Heart Lung Transplant. 2006 Jun;25(6):699-706
Mount Sinai Medical Center, New York, New York, USA.
Conventional immunosuppression for heart transplantation is
associated with various adverse effects. Tacrolimus monotherapy
(TM) is an alternative strategy that minimizes exposure to
additional immunosuppressants. METHODS: We retrospectively
reviewed clinical data for all adult transplant recipients
between January 1, 1996 and May 1, 2004. Clinical outcomes were
analyzed according to immunosuppressive regimen. RESULTS: A
total of 167 heart transplants were performed at our center.
Eight patients died before receiving calcineurin inhibitors and
were excluded from analysis. The mean follow-up for the 159
surviving patients was 1,520 +/- 78 days. Ninety of 124 patients
initially treated with tacrolimus and corticosteroids were
weaned to TM without the use of an anti-proliferative agent
(Group A), resulting in an overall success rate of 75% at an
average of 271 +/- 18 days after transplant. The remaining 69
recipients were treated with other tacrolimus- or
cyclosporine-based regimens (Group B). Survival was
significantly greater in Group A. The prevalence of high-grade
rejection within the first year and incidence of cardiac
allograft vasculopathy were similar between groups. Ten patients
(11%) in Group A required recommencement of combination
immunosuppression at an average of 768 +/- 772 days.
CONCLUSIONS: TM is achievable in the majority of cardiac
transplant recipients. Patients who tolerated reduced
immunosuppression enjoyed greater survival than those treated
with other regimens, without additional high-grade rejection or
vasculopathy. These promising results remain to be confirmed in
a prospective trial.
PMID: 16730576 |
