Author + information
- Alistair Aaronson,
- Michelle Kittleson,
- Jignesh Patel,
- Matthew Rafiei,
- Ashley Osborne,
- David Chang,
- Lawrence Czer and
- Jon Kobashigawa
Over the past 2 decades, the development of cardiac allograft vasculopathy(CAV) in heart transplant(HTx) patients(pts) has not significantly changed. Randomized clinical trials comparing cyclosporine(CSA) and tacrolimus(TAC)-based regimens have not demonstrated significant differences in CAV development, but followup time has been short(2 yrs). Mycophenolate(MMF) has been shown in a large randomized trial to decrease first yr intimal thickening in HTx pts compared to azathioprine (both groups with CSA). TAC/MMF vs CSA/MMF in the 3-Arm Trial significantly reduced rejection but followup time was insufficient to assess for CAV. To assess for a possible CAV benefit, we reviewed our pts maintained on TAC/MMF vs CSA/MMF for development of CAV over 5 yrs.
Between 1994-2010, we evaluated 728 HTx pts. CAV was defined as any angiographic stenosis ≥ 30%. Pts were divided into those maintained on CSA/MMF(n = 273) and TAC/MMF(n = 455). 5 yr actuarial survival, freedom from CAV and freedom from non-fatal major adverse cardiac events(NF-MACE) were assessed.
Pts treated with TAC/MMF vs CSA/MMF had significantly greater freedom from CAV(81% vs 74%, p=0.044). Survival and NF-MACE were similar (table). CAV severity according to the ISHLT CAV nomenclature was similar in CSA/MMF vs TAC/MMF (CAV1: 59% vs 65%, p = 0.57; CAV2: 19% vs. 14%, p = 0.52; CAV3: 22% vs 21%, p = 0.92).
TAC/MMF appears to have a beneficial effect in decreasing the incidence of CAV post-HTx.
|Outcomes||CSA/MMF (N = 273)||TAC/MMF (N = 455)||p-value|
|5-Year Actuarial Survival||78%||83%||0.133|
|5-Year Freedom from CAV||74%||81%||0.044|
|5-Year Freedom from NF-MACE||84%||84%||0.868|
|1-Year Freedom from Any-Treated Rejection||88%||85%||0.349|
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Challenges and Clinical Outcomes in Cardiac Transplantation
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1309-306
- 2013 American College of Cardiology Foundation