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Abstract: Background: In the last decade, mTOR inhibitors (mTOR-is) have become the cornerstone of the calcineurin inhibitor (CNI)-reduced/free regimens aimed to the preservation of post-transplant renal function. We compared utility and safety of the total replacement of calcineurin inhibitors with a mTOR-i with a strategy based on calcineurin inhibitor minimization and concomitant use of m-TOR-i. Methods: In a retrospective multi-center cohort of 394 maintenance cardiac recipients with renal failure (GFR<60 mL/min/1.73 m(2)), we compared 235 patients in whom CNI was replaced with a mTOR-i (sirolimus or everolimus) with 159 patients in whom mTOR-is were used to minimize CNIs. A propensity score analysis was carried out to balance between group differences. Results: Overall, after a median time of 2 years from mTOR-i initiation, between group differences for the evolution of renal function were not observed. In a multivariate adjusted model, improvement of renal function was limited to patients with mTOR-i usage within 5years after transplantation, particularly with the conversion strategy, and in those patients who could maintain mTOR-i therapy. Significant differences between strategies were not found for mortality, infection and mTOR-i withdrawal due to drug-related adverse events. However, conversion group tended to have a higher acute rejection incidence than the minimization group (p=0.07). Conclusion: In terms of renal benefits, our results support an earlier use of mTOR-is, irrespective of the strategy. The selection of either a conversion or a CNI minimization protocol should be based on the clinical characteristics of the patients, particularly their rejection risk
Fuente: International Journal of Cardiology, 2014, 171(1), 15-23
Editorial: Elsevier
Año de publicación: 2014
Nº de páginas: 9
Tipo de publicación: Artículo de Revista
DOI: 10.1016/j.ijcard.2013.11.036
ISSN: 0167-5273,1874-1754
Url de la publicación: http://dx.doi.org/10.1016/j.ijcard.2013.11.036
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FRANCISCO JESUS GONZALEZ VILCHEZ
JOSE ANTONIO VAZQUEZ DE PRADA TIFFE
PANIAGUA, M. J.
GOMEZ-BUENO, M.
ARIZON, J. M.
ALMENAR, L.
ROIG, E.
DELGADO, J.
LAMBERT, J. L.
PEREZ-VILLA, F.
SANZ-JULVE, M.L.
CRESPO-LEIRO, M.
SEGOVIA, J.
LÓPEZ-GRANADOS, A.
MARTINEZ-DOLZ, L.
MIRABET, S.
ESCRIBANO, P.
DIAZ-MOLINA, B.
FARRERO, M.
BLASCO, T.
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