Lubitz SA, Baran DA, Alwarshetty MM, Pinney S, Kaplan S, Chan M,
Courtney MC, Lansman SL, Spielvogel D, Gass AL.Long-term
Results of Tacrolimus Monotherapy in Cardiac Transplant
Recipients.
J Heart Lung Transplant. 2006 Jun;25(6):699-706
Mount Sinai Medical Center, New York, New York, USA.
BACKGROUND: 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
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