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DOI: 10.1055/s-2004-816845
Complete immunosuppressive conversion from Calcineurin-inhibitors to Mycophenolate Mofetil and steroids in cardiac transplant recipients with chronic renal failure
Background: Chronic renal failure (CRF) is a common complication following cardiac transplantation (HTX) associated with calcineurin-inhibitor-(CNI)-based immunosuppression. The aim of this prospective study was to evaluate the impact of a immunosuppressive conversion from CNIs to Mycophenolate Mofetil (MMF) and steroids only in cardiac transplant recipients with CRF on renal and cardiac graft function.
Methods: Twelve HTx-recipients (10 men; 3.3 to 18.2 years after transplantation) with CNI-based immunosuppression and a serum creatinine level >1.9mg/dl were included. Serum creatinine was monitored to detect renal function. Mean patient age was 56.1±3.6 years (range 51–63years). MMF was started with 0.5g/d and adjusted according fasting target trough levels [2–4 ng/ml]. Prednisone was administered with 0.4mg/kg. Subsequently, the CNI was tapered down and finally stopped. Clinical follow up (1 month after conversion and every three month thereafter) included endomyocardial biopsies, echocardiography and laboratory studies.
Results: After a mean follow up of 18±15 months renal function improved significantly: creatinine pre vs. post conversion: 2.9±0.7mg/dl vs. 2.1±0.8mg/dl, p=0.03. However, 3 acute rejection episodes occurred (>1b ISHLT) and were treated with steroid bolus and reconversion to CNIs. Although left ventricular fractional shortening remained stable (pre vs. post conversion: 33.1±8% vs. 30.1±9%), 6 patients had a new onset of graft vessel disease 10.1±7.2 months after conversion. There was no other serious adverse event leading to exclusion or reconversion.
Conclusions: Conversion from CNI-based immunosuppression to MMF and steroids after HTx improves renal function, but increase the risk for recurrent rejection and should be considered in patients with low risk for rejection.