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Effect of everolimus introduction on cardiac allograft vasculopathy--results of a randomized, multicenter trial.

Author(s): Arora S, Ueland T, Wennerblom B, Sigurdadottir V, Eiskjaer H, Botker HE, Ekmehag B, Jansson K, Mortensen SA, Saunamaki K, Simonsen S, Gude E, Bendz B, Solbu D, Aukrust P, Gullestad L

Affiliation(s): Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.

Publication date & source: 2011-07-27, Transplantation., 92(2):235-43.

Publication type: Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

BACKGROUND: Everolimus reduces the progression of cardiac allograft vasculopathy (CAV) in de novo heart transplant (HTx) recipients, but the influence on established CAV is unknown. METHODS: In this Nordic Certican Trial in Heart and lung Transplantation substudy, 111 maintenance HTx recipients (time post-HTx 5.8 +/- 4.3 years) randomized to everolimus+reduced calcineurin inhibitor (CNI) or standard CNI had matching (intravascular ultrasound) examinations at baseline and 12 months allowing accurate assessment of CAV progression. RESULTS: No significant difference in CAV progression was evident between the treatment groups (P = 0.30). When considering patients receiving concomitant azathioprine (AZA) therapy (n = 39), CAV progression was attenuated with everolimus versus standard CNI (Deltamaximal intimal thickness 0.00 +/- 0.04 and 0.04 +/- 0.04 mm, Deltapercent atheroma volume 0.2% +/- 3.0% and 2.6% +/- 2.5%, and Deltatotal atheroma volume 0.25 +/- 14.1 and 19.8 +/- 20.4 mm(3), respectively [P < 0.05]). When considering patients receiving mycophenolate mofetil (MMF), accelerated CAV progression occurred with everolimus versus standard CNI (Deltamaximal intimal thickness 0.06 +/- 0.12 vs. 0.02 +/- 0.06 mm and Deltapercent atheroma volume 4.0% +/- 6.3% vs. 1.4% +/- 3.1%, respectively; P < 0.05). The levels of C-reactive protein and vascular cell adhesion molecule-1 declined significantly with AZA+everolimus, whereas MMF+everolimus patients demonstrated a significant increase in levels of C-reactive protein, vascular cell adhesion molecule-1, and von Willebrand factor. CONCLUSIONS: Conversion to everolimus and reduced CNI does not influence CAV progression among maintenance HTx recipients. However, background immunosuppressive therapy is important as AZA+everolimus patients demonstrated attenuated CAV progression and a decline in inflammatory markers, whereas the opposite pattern was seen with everolimus+MMF. The different effect of everolimus when combined with AZA versus MMF could potentially reflect hitherto unknown interactions.

Page last updated: 2011-12-09

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