Estamos realizando la búsqueda. Por favor, espere...
1583
37
170
29013
4402
2599
347
386
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.
Fuente: Clinical Transplantation, 2013, 27(6), E649-E658
Editorial: Wiley
Año de publicación: 2013
Nº de páginas: 10
Tipo de publicación: Artículo de Revista
DOI: 10.1111/ctr.12241
ISSN: 0902-0063,1399-0012
Leer publicación
FRANCISCO JESUS GONZALEZ VILCHEZ
JOSE ANTONIO VAZQUEZ DE PRADA TIFFE
PANIAGUA, MARÍA J.
ALMENAR, LUIS
MIRABET, SONIA
GÓMEZ-BUENO, MANUEL
DÍAZ-MOLINA, BEATRIZ
ARIZÓN, JOSE M.
DELGADO, JUAN
PÉREZ-VILLA, FÉLIX
CRESPO-LEIRO, MARÍA G.
MARTÍNEZ-DOLZ, LUIS
Volver