Document Detail

Differential effect of everolimus on progression of early and late cardiac allograft vasculopathy in current clinical practice.
MedLine Citation:
PMID:  23621161     Owner:  NLM     Status:  In-Data-Review    
Randomized trials showed that mTOR inhibitors prevent early development of cardiac allograft vasculopathy (CAV). However, the action of these drugs on CAV late after transplant is controversial, and their effectiveness for CAV prevention in clinical practice is poorly explored. In this observational study we included 143 consecutive heart transplant recipients who underwent serial intravascular ultrasound (IVUS), receiving either everolimus or mycophenolate as adjunctive therapy to cyclosporine. Ninety-one recipients comprised the early cohort, receiving IVUS at weeks 3-6 and year 1 after transplant, and 52 the late cohort, receiving IVUS at years 1 and 5 after transplant. Everolimus independently reduced the odds for early CAV (0.14 [0.01-0.77]; p = 0.02) but it did not appear to influence late CAV progression. High-dose statins were found to be associated with reduced CAV progression both early and late after transplant (p ≤ 0.05). Metabolic abnormalities, such as high triglycerides, were associated with late, but not with early CAV progression. By highlighting a differential effect of everolimus and metabolic abnormalities on early and late changes of graft coronary morphology, this observational study supports the hypothesis that everolimus may be effective for CAV prevention but not for CAV treatment, and that risk factors intervene in a time-dependent sequence during CAV development.
M Masetti; L Potena; M Nardozza; P Prestinenzi; N Taglieri; F Saia; V Pece; G Magnani; F Fallani; F Coccolo; A Russo; C Rapezzi; F Grigioni; A Branzi
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons     Volume:  13     ISSN:  1600-6143     ISO Abbreviation:  Am. J. Transplant.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100968638     Medline TA:  Am J Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1217-26     Citation Subset:  IM    
Copyright Information:
© Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.
Cardiovascular Department of the University of Bologna, Bologna, Italy.
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