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Renal-Sparing Protocol May Be Harmful If Performed Early Post-Heart Transplant

J. Patel, M. Johl, E. Kransdorf, M. Kittleson, S. Dimbil, R. Levine, D. Chang, L. Czer, J. Kobashigawa.

Cedars Sinai Medical Center, Los Angeles, CA.

Meeting: 2018 American Transplant Congress

Abstract number: B56

Keywords: Adverse effects, Heart transplant patients, Renal function

Session Information

Session Name: Poster Session B: Heart and VADs: All Topics

Session Type: Poster Session

Date: Sunday, June 3, 2018

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Purpose: Calcineurin inhibitors (CNIs) are associated with nephrotoxicity. Renal sparing protocol (RSP) with CNI free regimen using mycophenolate and a proliferation signal inhibitor may improve renal function in heart transplant (HTx) recipients. RSP is considered if creatinine (Cr) approaches 2.0mg/dl >6 mths post-transplant(post-tx). We assessed whether early (<2yrs post-tx) vs late (>2yrs post-tx) RSP initiation has advantages.

Methods: Between 1994-2013, 85 HTx pts were placed on RSP; 10 initiated <2yrs post-tx and 75 >2yrs post-tx. Cr, eGFR (MDRD) were evaluated at baseline and 1-yr post-RSP. Subsequent 2-yr survival, freedom from cardiac allograft vasculopathy(CAV) (≥30% angiographic stenosis), Non-Fatal Major Adverse Cardiac Events (NF-MACE: myocardial infarction, heart failure, coronary intervention, defibrillator/pacemaker implant, stroke) and treated rejection were assessed.

Results: Mean time to RSP initiation:1.5yrs early group vs 7.7yrs late group. eGFR significantly improved at 1-yr after RSP in early vs late group (+19.6 vs +2.0 mean, p=0.001). However, early group at 2yrs had lower survival and freedom from NF-MACE, any-treated or acute cellular rejection. No significant difference in 2-yr freedom from CAV, antibody-mediated and biopsy-negative rejection.(Table)

Conclusion: Early initiation of RSP helps renal function but subsequent outcomes are poor. RSP should be therefore performed later. Further confirmatory studies are warranted.

Endpoints Early RSP Initiation (n=10) Late RSP Initiation (n=75) P-Value
2-yr Survival (Subsequent) 50.0% 84.0% 0.002
2-yr Freedom from (Fr) CAV 90.0% 92.0% 0.505
2-yr Fr NF-MACE 80.0% 93.0% 0.028
2-yr Fr Any-Treated Rejection 70.0% 94.7% <0.0001
2-yr Fr Acute Cellular Rejection 80.0% 98.7% <0.0001
2-yr Fr Antibody-Mediated Rejection 100.0% 98.7% 0.785
2-yr Fr Biopsy Negative Rejection 90.0% 96.0% 0.245
Cr at RSP Initiation 2.1 ± 0.4 2.3 ± 0.9 0.336
eGFR at RSP Initiation, Mean±SD 28.4 ± 6.3 33.7 ± 18.5 0.529
Cr 1-Yr Post RSP 1.2 ± 1.1 1.9 ± 1.3 0.136
eGFR at 1-Yr Post-RSP, Mean±SD 48.0 ± 23.4 35.7± 16.3 0.219
[Delta] eGFR 1-Yr Post-RSP ±SD 19.6 ± 24.8 2.0 ± 10.6 0.0001

CITATION INFORMATION: Patel J., Johl M., Kransdorf E., Kittleson M., Dimbil S., Levine R., Chang D., Czer L., Kobashigawa J. Renal-Sparing Protocol May Be Harmful If Performed Early Post-Heart Transplant Am J Transplant. 2017;17 (suppl 3).

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To cite this abstract in AMA style:

Patel J, Johl M, Kransdorf E, Kittleson M, Dimbil S, Levine R, Chang D, Czer L, Kobashigawa J. Renal-Sparing Protocol May Be Harmful If Performed Early Post-Heart Transplant [abstract]. https://atcmeetingabstracts.com/abstract/renal-sparing-protocol-may-be-harmful-if-performed-early-post-heart-transplant/. Accessed June 4, 2025.

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