Background: The multicenter randomized trials of everolimus have demonstrated a significant reduction in 1st Year maximal intimal thickness. It has been demonstrated from a validation study that 1st year maximal intimal thickness > 0.5 mm results in more angiographic abnormalities at 5 years after transplant. We sought to verify this finding by following our patients on everolimus at the time of heart transplant for 5 years and comparing them to age-match-sex controls.

Methods: Between 1994 and 2010, we evaluated 800 heart transplant patients and divided them into initial immunosuppression groups which included: Cyclosporine (CYA)/Mycophenolate (MMF), tacrolimus (TAC)/MMF and CYA/everolimus (EVR). Patients were followed for 5 years after heart transplantation for survival, freedom from cardiac allograft vasculopathy (CAV: any angiographic stenosis ≥ 30%, including grades of CAV), freedom from non-fatal major adverse cardiac events (NF-MACE: MI, stroke, new onset CHF, percutaneous cardiac intervention, need for defibrillator/pacemaker), and 1-year freedom from rejection.

Results: There was no significant difference in 5 year survival and freedom from CAV or NF-MACE among the 3 groups. However, review of CAV severity found no ISHLT grade 2-3 CAV in the CYA/EVR group compared to the CYA/MMF and TAC/MMF groups (0% vs 38% vs 31%) but numbers are small.

Conclusion: Patients treated with proliferation signal inhibitors at the time of heart transplantation appear to develop less severe CAV compared to patients not on proliferation signal inhibitors. A larger study is warranted to confirm these findings.

Patel, J.: Grant/Research Support, Alexion Pharma. Kobashigawa, J.: Grant/Research Support, Novartis Pharmaceuticals, Other, Novartis Pharmaceuticals, Data Safety Monitoring Board.

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