The Effect of Everolimus Initiation and Calcineurin Inhibitor Elimination on Cardiac Allograft Vasculopathy in De Novo Recipients: One-Year Results of a Scandinavian Randomized Trial.

Arora, S; Andreassen, A K; Andersson, B; Gustafsson, F; Eiskjaer, H; Bøtker, H E; Rådegran, G; Gude, E; Ioanes, D; Solbu, D; Sigurdardottir, Vilborg; Dellgren, G; Erikstad, I; Solberg, O G; Ueland, T; Aukrust, P; Gullestad, L (2015). The Effect of Everolimus Initiation and Calcineurin Inhibitor Elimination on Cardiac Allograft Vasculopathy in De Novo Recipients: One-Year Results of a Scandinavian Randomized Trial. American journal of transplantation, 15(7), pp. 1967-1975. Wiley-Blackwell 10.1111/ajt.13214

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Early initiation of everolimus with calcineurin inhibitor therapy has been shown to reduce the progression of cardiac allograft vasculopathy (CAV) in de novo heart transplant recipients. The effect of de novo everolimus therapy and early total elimination of calcineurin inhibitor therapy has, however, not been investigated and is relevant given the morbidity and lack of efficacy of current protocols in preventing CAV. This 12-month multicenter Scandinavian trial randomized 115 de novo heart transplant recipients to everolimus with complete calcineurin inhibitor elimination 7-11 weeks after HTx or standard cyclosporine immunosuppression. Ninety-five (83%) patients had matched intravascular ultrasound examinations at baseline and 12 months. Mean (± SD) recipient age was 49.9 ± 13.1 years. The everolimus group (n = 47) demonstrated significantly reduced CAV progression as compared to the calcineurin inhibitor group (n = 48) (ΔMaximal Intimal Thickness 0.03 ± 0.06 and 0.08 ± 0.12 mm, ΔPercent Atheroma Volume 1.3 ± 2.3 and 4.2 ± 5.0%, ΔTotal Atheroma Volume 1.1 ± 19.2 mm(3) and 13.8 ± 28.0 mm(3) [all p-values ≤ 0.01]). Everolimus patients also had a significantly greater decline in levels of soluble tumor necrosis factor receptor-1 as compared to the calcineurin inhibitor group (p = 0.02). These preliminary results suggest that an everolimus-based CNI-free can potentially be considered in suitable de novo HTx recipients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Sigurdardottir, Vilborg

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1600-6135

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Vilborg Sigurdardottir

Date Deposited:

07 Mar 2016 09:56

Last Modified:

08 Mar 2016 03:11

Publisher DOI:

10.1111/ajt.13214

PubMed ID:

25783974

Uncontrolled Keywords:

clinical research / practice; heart (allograft) function / dysfunction; heart transplantation / cardiology; immunosuppressant; mechanistic target of rapamycin: everolimus

BORIS DOI:

10.7892/boris.76004

URI:

https://boris.unibe.ch/id/eprint/76004

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