Treatment With mTOR Inhibitors as Primary Immunosuppression After Combined Heart and Kidney Transplantation.

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure Pub Date : 2024-12-07 DOI:10.1016/j.cardfail.2024.10.451

Hilmi Alnsasra, Rabea Asleh, Fouad Khalil, Elias Akiki, Alexandros Briasoulis, Patrick G Dean, Andrew J Bentall, Sudhir S Kushwaha

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引用次数: 0

Abstract

Introduction: Sirolimus (SRL) mitigates cardiac allograft vasculopathy (CAV) progression and confers renal protection after heart transplantation (HT). However, its safety and efficacy in patients undergoing combined heart and kidney transplantation (HKT) are unclear. This study aimed to investigate the impact of conversion from calcineurin inhibitors (CNIs) to SRL on CAV progression, renal function, and outcomes in HKT compared with isolated HT.

Methods: A cohort of 302 patients who underwent either HT only (n = 262) or HKT (n = 40) was analyzed. CAV progression was assessed by measuring the delta (Δ) annual change in plaque volume (PV) and plaque index (PI) using coronary intravenous ultrasound (IVUS). Clinical adverse outcomes included all-cause death and CAV-associated events. Overall, 217 (72%) patients were converted from CNI to SRL as primary immunosuppression. HT recipients were more likely to be converted to SRL than HKT recipients (74% vs. 55%, P = .01).

Results: HKT was associated with higher Δ PV (P = .01) and a trend toward higher ΔPI (P = .06) than HT only, but this association was attenuated after adjustment to SRL conversion. HKT was associated with similar risk of death (HR, 0.98; 95% CI 0.39-2.5, P = 0.97) and CAV-related events (HR, 1.6; 95% CI 0.91-2.8, P = .10). Conversion to SRL was associated with decreased risk of death and CAV-related events in the overall cohort. This association was not modified by the type of organ transplantation and without a significant effect on estimated glomerular filtration rate or proteinuria.

Conclusion: Conversion to sirolimus as a primary immunosuppressant could be effective for either HT-only or HKT recipients.

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mTOR抑制剂作为心脏和肾脏联合移植后原发性免疫抑制的治疗。

目的：西罗莫司（SRL）减轻同种异体心脏移植血管病变（CAV）的进展，并在心脏移植（HT）后给予肾脏保护。然而，其在心脏和肾脏联合移植（HKT）患者中的安全性和有效性尚不清楚。本研究旨在探讨钙调磷酸酶抑制剂（CNI）转化为SRL对HKT患者CAV进展、肾功能和预后的影响。方法和结果：对302例接受单纯HT治疗（n=262）或HKT治疗（n=40）的患者进行队列分析。通过冠状动脉静脉超声（IVUS）测量斑块体积（PV）和斑块指数（PI）的年变化delta （Δ）来评估CAV的进展。临床不良结局包括全因死亡和cav相关事件。总体而言，217例（72%）患者因原发性免疫抑制而从CNI转为SRL。HT受体较HKT受体更容易转化为SRL （74% vs. 55%， P=0.01）。与单纯ht相比，HKT与更高的ΔPV （P=0.01）和更高的ΔPI （P=0.06）相关，但在调整SRL转换后，这种关联减弱。HKT与相似的死亡风险（HR 0.98, 95%CI: 0.39-2.5， P=0.97）和cav相关事件（HR 1.6, 95%CI: 0.91-2.8， P=0.10）相关。在整个队列中，转换为SRL与死亡和cav相关事件的风险降低有关。这种关联不受器官移植类型的影响，对肾小球滤过率或蛋白尿的估计也没有显著影响。结论：将西罗莫司转换为原发性免疫抑制剂对ht受体或HKT受体均有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Failure 医学-心血管系统

CiteScore

7.80

自引率

8.30%

发文量

653

审稿时长

21 days

期刊介绍： Journal of Cardiac Failure publishes original, peer-reviewed communications of scientific excellence and review articles on clinical research, basic human studies, animal studies, and bench research with potential clinical applications to heart failure - pathogenesis, etiology, epidemiology, pathophysiological mechanisms, assessment, prevention, and treatment.