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  • Title: Rejection after conversion to a proliferation signal inhibitor in chronic heart transplantation.
    Author: González-Vílchez F, Vázquez de Prada JA, Paniagua MJ, Almenar L, Mirabet S, Gómez-Bueno M, Díaz-Molina B, Arizón JM, Delgado J, Pérez-Villa F, Crespo-Leiro MG, Martínez-Dolz L, Roig E, Segovia J, Lambert JL, Lopez-Granados A, Escribano P, Farrero M.
    Journal: Clin Transplant; 2013; 27(6):E649-58. PubMed ID: 24025040.
    Abstract:
    We sought to determine the incidence, risk factors, and consequences of acute rejection (AR) after conversion from a calcineurin inhibitor (CNI) to a proliferation signal inhibitor (PSI) in maintenance heart transplantation. Relevant clinical data were retrospectively obtained for 284 long-term heart transplant recipients from nine centers in whom CNIs were replaced with a PSI (sirolimus or everolimus) between October 2001 and March 2009. The rejection rate at one yr was 8.3%, stabilizing to 2% per year thereafter. The incidence rate after conversion (4.9 per 100 patient-years) was significantly higher than that observed on CNI therapy in the pre-conversion period (2.2 per 100 patient-years). By multivariate analysis, rejection risk was associated with a history of late AR prior to PSI conversion, early conversion (<5 yr) after transplantation and age <50 yr at the time of conversion. Use of mycophenolate mofetil was a protective factor. Post-conversion rejection did not significantly influence the evolution of left ventricular ejection fraction, renal function, or mortality during further follow-up. Conversion to a CNI-free immunosuppression based on a PSI results in an increased risk of AR. Awareness of the clinical determinants of post-conversion rejection could help to refine the current PSI conversion strategies.
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