Renal-Sparing Protocol May Be Harmful If Performed Early Post-Heart Transplant
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).
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 November 21, 2024.« Back to 2018 American Transplant Congress