77 Effect of Everolimus Introduction and Calcineurin Inhibitor Reduction on Cardiac Allograft Vasculopathy Assessed by Virtual Histology

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• 作者：S. Arora¹ ; I. Erikstad¹ ; B. Wennerblom² ; V. Sigurdardottir² ; H. Eiskjæ ; r³ ; H. Bø ; tker³ ; S.-A. Mortensen⁴ ; K. Saunameki⁴ ; B. Ekmehag⁵ ; K. Jansson⁶ ; S. Simonsen¹ ; E. Gude¹ ; A. Ragnarsson¹ ; D. Solbu⁷ ; L. Gullestad¹
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2011
• 出版时间：April, 2011
• 年：2011
• 卷：30
• 期：4_supp_S
• 页码：S33-S34
• 全文大小：1K

文摘

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lass=""h4"">Purpose

Immunosuppressant regimes centered on everolimus have been demonstrated to provide a quantitative reduction in cardiac allograft vasculopathy (CAV) amongst de-novo heart transplant (HTx) recipients. However, the effect of such therapy on CAV assessed by the qualitative method of Virtual Histology (VH) is unknown and was investigated in this prospective randomized-controlled trial.

lass=""h4"">Methods and Materials

In this 12-month multicenter Scandinavian study 190 maintenance HTx recipients were randomized to everolimus with reduced calcineurin inhibitor (CNI) exposure or continue standard CNI-therapy. Both groups continued their prior usage of azathioprine (AZA) or mycophenolate mofetil (MMF). 78 patients had evaluable VH examinations at baseline and 12 months and matched analysis was performed to measure change in fibrotic, fibrofatty, calcified and necrotic tissue component.

lass=""h4"">Results

When considering all 78 patients, mean age 57.4¡À10.3 years and mean time post-HTx 5.4¡À4.1 yrs, a similar rate of quantitative CAV progression was observed in the everolimus (n=30) versus standard CNI therapy group (n=48) (plaque index 1.9¡À3.9 % and 1.6¡À3.7 % , respectively; p=0.65). Virtual Histology analysis revealed a significant increase in calcified (2.4¡À4.0 versus 0.3¡À3.1 % ; p=0.02) and necrotic component (6.4¡À8.5 versus 1.0¡À8.6 % ; p<0.01) amongst everolimus patients as compared to standard CNI therapy, respectively. Increase in calcified and necrotic component was significantly greater (p<0.05) in everolimus patients as compared to controls irrespective of background immunosuppression (AZA or MMF). Change in fibrotic and fibrofatty tissue was not significantly different in the everolimus and control group (p>0.05).

lass=""h4"">Conclusions

Conversion to everolimus and reduced CNI does not significantly influence quantitative progression of CAV but is associated with a significant increase in calcified and necrotic tissue component. The prognostic implication of these qualitative changes in HTx recipients is unclear and warrants further investigation.