Calcineurin Inhibitor (CNI) Delay with ATG Induction: Teaching an Old Dog, New Tricks.
1Cardiac Surgery, Medical University of Vienna, Vienna, Austria
2Cardiothoracic and Vascular Anaesthisiology, Medical University of Vienna, Vienna, Austria.
Meeting: 2016 American Transplant Congress
Abstract number: B152
Keywords: Calcineurin, Heart transplant patients, Immunosuppression, Induction therapy
Session Information
Session Name: Poster Session B: Hearts and VADs in Depth - The Force Awakens
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
CNI delay early after heart transplantation is a recommended therapeutic option according to ISHLT guidelines. However, there exist only few published data on feasibility of CNI delay. The aim of this single center retrospective study was to analyze safety and efficacy of CNI delay with ATG induction therapy.
A total of 706 patients were transplanted at our center from 1/96-9/14. All patients received thymoglobuline induction therapy for 1-10 days. CNI therapy was started after the end of ATG-induction. Patients were grouped according to CNI start day (0-1, 2-3, 4-5, 6-7, >7). Freedom from rejection at 1 and 12 months was analyzed in each group by Kaplan-Meier analysis with log-rank test. Changes of creatinine levels (Crea) pre-transplant (preTX) vs. 7 days post-transplant (7d PostTX) were compared in all groups and in sub-groups with crea preTX levels >1.5mg/dl. Differences were analyzed with paired t-test. P-values <0.05 were defined as significant.
Group 0-1 consisted of 20 patients (Crea>1.5mg/ml: n=8; 40%), 2-3: n=173 (n=30, 17%), 4-5: n=219 (n=53; 24%), 6-7: n=224 (n=64; 29%), >7: n=70 (n=25; 36%). Freedom from acute rejection at 1 and 12 months post transplant were: 0-1: 100%, 95%; 2-3: 92.4%, 88.4%; 4-5: 95%, 91.3%; 6-7: 93.3%, 87.5% and >7: 88.6%, 82.9%; p=0.282). Whereas there was no significant change between preTX Crea and 7d postTX in the 0-1 (1.68±1.11 vs. 1.69±1.18) and >7 groups (1.59±1.02 vs. 1.32±0.8), there was significant improvement in groups 2-3 (1.35±0.82 vs. 1.18±0.61; p<0.001), 4-5 (1.43±0.85 vs. 1.21±0.46; p<0.001) and 6-7 (1.42±0.63 vs. 1.18±0.56; p<0.001). In patients with preTX crea >1.5 there was also significant improvement in crea 7d postTX in most groups. 2-3 (2.15±1.52 vs. 1.71±1.00; p<0.01), 4-5 (2.13±1.32 vs. 1.41±0.48; p<0.001), 6-7 (2.02±0.78 vs. 1.48±0.50; p<0.001), >7 (1.78±0.51 vs. 1.42±0.50; p<0.01). Only group 0-1 showed no improvement (2.55±1.35 vs. 2.38±1.54; p=n.s.).
CNI delay of 2 to even >7 days in combination with ATG induction seems to be associated with low rejection rates and improvement of early renal function. Prospective studies are needed.
CITATION INFORMATION: Aliabadi A, Goekler J, Salameh O, Haberl T, Steinlechner B, Opfermann P, Kaider A, Uyanik-Uenal K, Laufer G, Zuckermann A. Calcineurin Inhibitor (CNI) Delay with ATG Induction: Teaching an Old Dog, New Tricks. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Aliabadi A, Goekler J, Salameh O, Haberl T, Steinlechner B, Opfermann P, Kaider A, Uyanik-Uenal K, Laufer G, Zuckermann A. Calcineurin Inhibitor (CNI) Delay with ATG Induction: Teaching an Old Dog, New Tricks. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/calcineurin-inhibitor-cni-delay-with-atg-induction-teaching-an-old-dog-new-tricks/. Accessed May 9, 2025.« Back to 2016 American Transplant Congress