When is the Optimal Time to Initiate the Renal-Sparing Protocol with Calcineurin Inhibitor Withdrawal?
Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
Meeting: 2021 American Transplant Congress
Abstract number: 405
Keywords: Glomerular filtration rate (GFR), Renal function
Topic: Clinical Science » Heart » Heart and VADs: All Topics
Session Information
Session Time: 7:30pm-8:30pm
Presentation Time: 7:50pm-8:00pm
Location: Virtual
*Purpose: Renal dysfunction after heart transplantation (HTx) has been associated with higher morbidity and mortality. The most common cause of this renal dysfunction is the use of calcineurin inhibitors (CNIs). Many programs will utilize a renal sparing protocol (RSP) after 6-months post-transplant whereby the CNI is tapered off with the addition of a proliferation signal inhibitor added to the pre-existing mycophenolate mofetil. It is believed that weaning RSP earlier during renal dysfunction leads to better outcome. We sought to answer this question with review of our RSP experience.
*Methods: Between 1994-2017, we assessed 61 heart transplant patients with elevated creatinine. RSP was started at creatinine 1.5-2.0, 2.1-2.5, and 2.6-3.0 mg/dL. Renal function was measured by serum creatinine and glomerular filtration rate (GFR) at 6- and 12-months following initiation of RSP.
*Results: RSP initiated at the lowest elevation of serum creatinine resulted in a higher GFR compared to RSP at higher ranges. However, the overall improvement from baseline was similar (change in GFR around 9 cc/min., see table). The average time between transplant and initiation of RSP was 5.3 ± 4.2 years.
*Conclusions: RSP performed at earlier rising serum creatinine appears most beneficial in terms of restoring optimal kidney function.
| Endpoints | Creatinine 1.5-2.0 mg/dL (n=21) | Creatinine 2.1-2.5 mg/dL (n=22) | Creatinine 2.6-3.0 mg/dL (n=18) | P-Value |
| Serum creatinine @ RSP initiation | 1.80 ± 0.18 | 2.28 ± 0.13 | 2.75 ± 0.12 | <0.001 |
| Serum creatinine 6 months after RSP initiation | 1.58 ± 0.39 | 1.85 ± 0.35 | 2.21 ± 0.52 | <0.001 |
| GFR @ RSP initiation | 37.91 ± 5.40 | 29.28 ± 3.59 | 22.99 ± 2.51 | <0.001 |
| GFR 6 months after RSP initiation | 46.99 ± 15.42 | 38.88 ± 9.98 | 31.24 ± 7.80 | <0.001 |
| ΔGFR (% change) | 9.08 ± 13.44 (23.95%) | 9.60 ± 9.19 (32.79%) | 8.25 ± 7.56 (35.89%) | 0.921 |
To cite this abstract in AMA style:
Patel N, Kittleson M, Patel J, Singer-Englar T, Kim S, Chang D, Azarbal B, Nikolova A, Czer L, Esmailian F, Kobashigawa JA. When is the Optimal Time to Initiate the Renal-Sparing Protocol with Calcineurin Inhibitor Withdrawal? [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/when-is-the-optimal-time-to-initiate-the-renal-sparing-protocol-with-calcineurin-inhibitor-withdrawal/. Accessed June 21, 2025.« Back to 2021 American Transplant Congress