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 July 22, 2019.
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