Author + information
- Dael R. Geft,
- Jignesh Patel,
- Michelle Kittleson,
- David Chang,
- Matthew Rafiei,
- Ashley Osborne,
- Lawrence Czer,
- Fardad Esmailian and
- Jon Kobashigawa
The Cylex immune monitoring(CIM) test represents T-cell function under immunosuppression. It has been reported that CIM can predict risk of infection (infn) and to a lesser degree risk of rejection after heart transplant (HTx). Recently, use of CIM to guide immunosuppression was shown to reduce infns in a randomized trial of liver transplant patients (pts). Similar benefit with use of CIM to guide immunotherapy after HTx has not been established.
Between 8/2005 and 5/2012 we evaluated 381 HTx pts. Prior to 1/2010, 196 HTx pts’ immunosuppression was guided by trough drug blood levels. Following 1/2010, CIM was also used to help guide therapy for 185 pts. In general, for CIM scores <200 ATP ng/ml, immunosuppression was reduced with decrease in tacrolimus (TAC)/cyclosporine (CSA) or mycophenolate (MMF) dose. High CIM levels were not addressed. Freedom from 1st-year infn was assessed for time periods 8/2005-12/2009 and 1/2010–5/2012.
Pts who had immunosuppression guided by CIM vs drug trough levels alone had significantly greater freedom from 1st-year infn after HTx (62% vs 51%, p=0.029). 1st year freedom from any-treated rejection was similar between groups. After 1/2010, for CIM scores <200, a decrease in immunosuppression drugs occurred 73% of the time. Two-thirds of the time MMF was reduced (by ∼25%) while one-third of the time TAC/CSA was reduced (by ∼25%).
|Endpoints||Routine Use Before 2010 (N = 196)||Guided Use After 2010 (N = 185)||p-value|
|1-Year Freedom from Infection, n (%)||99 (51%)||114 (62%)||0.029|
|1-Year Freedom from Any-Treated Rejection in Patients, n (%)||167 (85%)||168 (91%)||0.094|
|1-Year Survival, n (%)||180 (92%)||179 (97%)||0.040|
The use of CIM (low scores) to guide immunosuppression in HTx appears to be beneficial to avoid risk of infection.
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: 1309-308
- 2013 American College of Cardiology Foundation