Suppressive effects of conversion from mycophenolate mofetil to everolimus for the development of cardiac allograft vasculopathy in maintenance of heart transplant recipients

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• 作者：Takuya Watanabe^a ; ^b ; Osamu Seguchi^a ; Kunihiro Nishimura^c ; Tomoyuki Fujita^d ; Yoshihiro Murata^a ; ^e ; Masanobu Yanase^a ; Takuma Sato^a ; Haruki Sunami^a ; Seiko Nakajima^a ; Eriko Hisamatsu^a ; Takamasa Sato^a ; Kensuke Kuroda^a ; Michinari Hieda^f ; Kyoichi Wada^g ; Hiroki Hata^d ; Hatsue Ishibashi-Ueda^h ; Yoshihiro Miyamoto^b ; ^c ; Norihide Fukushima^a ; Junjiro Kobayashi^d ; Takeshi Nakatani^a ; ^{nakatani.takeshi.hp@mail.ncvc.go.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：%PVI ; percent plaque volume index ; 3D-IVUS ; three-dimensional intravascular ultrasound ; AZA ; azathioprine ; CAV ; cardiac allograft vasculopathy ; CMV ; cytomegalovirus ; CNIs ; calcineurin inhibitors ; EEM ; external elastic membrane ; EVL ; everolimus ; GFR ; glomerular filtration rate ; HTx ; heart transplantation ; ISHLT ; International Society of Heart and Lung Transplantation ; LVI ; lumen volume index ; MIT ; maximal intimal thickness ; MMF ; mycophenolate mofetil ; mTOR ; mammalian target of rapamycin ; NCVC ; Na
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 January 2016
• 年：2016
• 卷：203
• 期：Complete
• 页码：307-314
• 全文大小：652 K

文摘

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.