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Change in treatment after heart transplantation may improve outcome

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ISHLT 31st Annual Meeting and Scientific Sessions

SAN DIEGO – Following heart transplantation, everolimus-based immunosuppression and a reduction of cyclosporine dose was safe and improved renal function compared with conventional treatment in more than 200 patients. Further, researchers found that it may also reduce the incidence of lymphomas.

Researchers of the prospective, randomized trial randomly assigned patients (n=213, >18 years of age) stratified by age, gender, creatinine and presence of coronary artery disease into one of two groups: cyclosporine reduction plus everolimus-based (EVL) immunosuppression (n=108) or conventional treatment (n=105). They defined improvement in renal function as an increase greater than 5 ml/min.

What they found was that renal function improved in EVL patients (37.4% vs. 13.9%; P<.001). Also reported was an increase in creatinine the conventional arm (P<.01) whereas no statistically significant increase was found in the EVL arm.

Additionally, at 3 years Modification of Diet in Renal Disease (MDRD) lowered in conventionally treated patients (P<.01), while a modest improvement was found in the EVL group. Similarly, benefits in lymphoma incidence were also reported in the EVL group, as no one had a lymphoma vs. six in the conventional group (P=.04).

These findings led Roberto Fiocchi, MD, PhD, with the Heart Transplantation Center, Ospedali Riuniti di Bergamo, Bergamo, Italy, and study investigator, to conclude in his presentation that this practice is feasible. However, “You have to know that there is a significantly higher incidence rate of one infection [in the EVL group],” he said. “These observations raise the question can we improve survival? We don’t know yet.” – by Brian Ellis

Disclosure: Dr. Fiocchi serves on the speakers’ bureau for Novartis.

For more information:

• Fiocchi R. Featured Abstract #1. Presented at: ISHLT 31st Annual Meeting and Scientific Sessions; April 13-16, 2011; San Diego.

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