Takuya Watanabe1, Osamu Seguchi2, Kunihiro Nishimura3, Tomoyuki Fujita4, Yoshihiro Murata5, Masanobu Yanase2, Takuma Sato2, Haruki Sunami2, Seiko Nakajima2, Eriko Hisamatsu2, Takamasa Sato2, Kensuke Kuroda2, Michinari Hieda6, Kyoichi Wada7, Hiroki Hata4, Hatsue Ishibashi-Ueda8, Yoshihiro Miyamoto9, Norihide Fukushima2, Junjiro Kobayashi4, Takeshi Nakatani10. 1. Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 2. Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 3. Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 4. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 5. Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Cardiology, Kumiai Kosei Hospital, Takayama, Gifu, Japan. 6. Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 7. Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 8. Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 9. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 10. Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: nakatani.takeshi.hp@mail.ncvc.go.jp.
Abstract
BACKGROUND: Whether converting to everolimus (EVL) from mycophenolate mofetil (MMF) during the maintenance period after heart transplantation (HTx) reduces cardiac allograft vasculopathy (CAV) progression remains unclear. We sought to determine the effect of converting from MMF with standard-dose calcineurin inhibitors (CNIs) to EVL with low-dose CNIs on CAV progression. METHODS: We retrospectively reviewed the medical records of 63 HTx recipients who survived at least at 1 year after HTx. Twenty-four recipients were converted from MMF to EVL (EVL group, 2.2 ± 2.3 years after HTx), while 39 recipients were maintained on MMF (MMF group, 2.4 ± 2.2 years after HTx). The EVL group underwent three-dimensional intravascular ultrasound (3D-IVUS) analysis before and 1 year after conversion to EVL, and these data were compared with data from 2 consecutive IVUS in the MMF group. RESULTS: IVUS indices in the EVL group at 1 year after conversion did not show increased CAV development, whereas a significant increase in %plaque volume (p=0.006) and decrease in lumen volume (p<0.001) were observed in the MMF group. EVL conversion was significantly associated with smaller increases in %plaque volume (p=0.004) and smaller decreases in lumen volume (p=0.017). IVUS indices in the late EVL conversion group (≥ 2 years) also did not exhibit increased CAV development, while those in the MMF group did. CONCLUSIONS: Conversion to EVL from MMF in maintenance periods after HTx may decrease the rate of CAV progression based on IVUS indices.
BACKGROUND: Whether converting to everolimus (EVL) from mycophenolate mofetil (MMF) during the maintenance period after heart transplantation (HTx) reduces cardiac allograft vasculopathy (CAV) progression remains unclear. We sought to determine the effect of converting from MMF with standard-dose calcineurin inhibitors (CNIs) to EVL with low-dose CNIs on CAV progression. METHODS: We retrospectively reviewed the medical records of 63 HTx recipients who survived at least at 1 year after HTx. Twenty-four recipients were converted from MMF to EVL (EVL group, 2.2 ± 2.3 years after HTx), while 39 recipients were maintained on MMF (MMF group, 2.4 ± 2.2 years after HTx). The EVL group underwent three-dimensional intravascular ultrasound (3D-IVUS) analysis before and 1 year after conversion to EVL, and these data were compared with data from 2 consecutive IVUS in the MMF group. RESULTS: IVUS indices in the EVL group at 1 year after conversion did not show increased CAV development, whereas a significant increase in %plaque volume (p=0.006) and decrease in lumen volume (p<0.001) were observed in the MMF group. EVL conversion was significantly associated with smaller increases in %plaque volume (p=0.004) and smaller decreases in lumen volume (p=0.017). IVUS indices in the late EVL conversion group (≥ 2 years) also did not exhibit increased CAV development, while those in the MMF group did. CONCLUSIONS: Conversion to EVL from MMF in maintenance periods after HTx may decrease the rate of CAV progression based on IVUS indices.