Suppressive effects of conversion from mycophenolate mofetil to everolimus for the development of cardiac allograft vasculopathy in maintenance of heart transplant recipients. (15th January 2016)

• Record Type: Journal Article
• Authors: Watanabe, Takuya; Seguchi, Osamu; Nishimura, Kunihiro; Fujita, Tomoyuki; Murata, Yoshihiro; Yanase, Masanobu; Sato, Takuma; Sunami, Haruki; Nakajima, Seiko; Hisamatsu, Eriko; Sato, Takamasa; Kuroda, Kensuke; Hieda, Michinari; Wada, Kyoichi; Hata, Hiroki; Ishibashi-Ueda, Hatsue; Miyamoto, Yoshihiro; Fukushima, Norihide; Kobayashi, Junjiro; Nakatani, Takeshi
• Is Part Of: International journal of cardiology. Volume 203(2016)
• Page Start: 307
• Page End: 314
• Publication Date: 2016-01-15
• Subjects: %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 National Cerebral and Cardiovascular Center -- PVI plaque volume index -- VVI vessel volume index; Heart transplantation -- Cardiac allograft vasculopathy -- Everolimus -- Three-dimensional intravascular ultrasound; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.10.082
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: 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.