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Abstract: Introduction and objectives: Intrapatient blood level variability (IPV) of calcineurin inhibitors has been associated with poor outcomes in solid-organ transplant, but data for heart transplant are scarce. Our purpose was to ascertain the clinical impact of IPV in a multi-institutional cohort of heart transplant recipients. Methods: We retrospectively studied patients aged ? 18 years, with a first heart transplant performed between 2000 and 2014 and surviving ? 1 year. IPV was assessed by the coefficient of variation of trough levels from posttransplant months 4 to 12. A composite of rejection or mortality/graft loss or rejection and all-cause mortality/graft loss between years 1 to 5 posttransplant were analyzed by Cox regression analysis. Results: The study group consisted of 1581 recipients (median age, 56 years; women, 21%). Cyclosporine immediate-release tacrolimus and prolonged-release tacrolimus were used in 790, 527 and 264 patients, respectively. On multivariable analysis, coefficient of variation > 27.8% showed a nonsignificant trend to association with 5-year rejection-free survival (HR, 1.298; 95%CI, 0.993-1.695; P = .056) and with 5-year mortality (HR, 1.387; 95%CI, 0.979-1.963; P = .065). Association with rejection became significant on analysis of only those patients without rejection episodes during the first year posttransplant (HR, 1.609; 95%CI, 1.129-2.295; P = .011). The tacrolimus-based formulation had less IPV than cyclosporine and better results with less influence of IPV. Conclusions: IPV of calcineurin inhibitors is only marginally associated with mid-term outcomes after heart transplant, particularly with the tacrolimus-based immunosuppression, although it could play a role in the most stable recipients
Fuente: Revista espanola de cardiologia (English ed.), 2022, 7582), 129-140
Año de publicación: 2022
Nº de páginas: 12
Tipo de publicación: Artículo de Revista
DOI: 10.1016/j.rec.2021.02.001
ISSN: 0300-8932,1579-2242,1885-5857
Url de la publicación: https://doi.org/10.1016/j.rec.2021.02.001
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FRANCISCO JESUS GONZALEZ VILCHEZ
CRESPO-LEIRO, MARÍA G.
DELGADO-JIMÉNEZ, JUAN
PÉREZ-VILLA, FÉLIX
SEGOCIA-CUBERO, JAVIER
DÍEZ-MOLINA, BEATRIZ
MIRABET-PÉREZ, SONIA
ARIZÓN DEL PRADO, JOSÉ MARÍA
BLACO-PEIRÓ, TERESA
MARTÍNEZ-SELLÉS, MANUEL
ALEMNAR-BONET, LUIS
GARRIDO-BRAVO, IRIS
RÁBAGO, GREGORIO
JOSE ANTONIO VAZQUEZ DE PRADA TIFFE
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