Reduced Progression of Cardiac Allograft Vasculopathy with Routine Use of Induction Therapy with Basiliximab

Abstract

BackgroundCardiac allograft vasculopathy (CAV) is a major limitation for long-term survival of patients undergoing heart transplantation (HT). Some immunosuppressants can reduce the risk of CAV.ObjectivesThe primary objective was to evaluate the variation in the volumetric growth of the intimal layer measured by intracoronary ultrasound (IVUS) after 1 year in patients who received basiliximab compared with that in a control group.MethodsThirteen patients treated at a single center between 2007 and 2009 were analyzed retrospectively. Evaluations were performed with IVUS, measuring the volume of a coronary segment within the first 30 days and 1 year after HT. Vasculopathy was characterized by the volume of the intima of the vessel.ResultsThirteen patients included (7 in the basiliximab group and 6 in the control group). On IVUS assessment, the control group was found to have greater vessel volume (120–185.43 mm3 vs. 127.77–131.32 mm3; p = 0.051). Intimal layer growth (i.e., CAV) was also higher in the control group (27.30–49.15 mm3 [∆80%] vs. 20.23–26.69 mm3 [∆33%]; p = 0.015). Univariate regression analysis revealed that plaque volume and prior atherosclerosis of the donor were not related to intima growth (r = 0.15, p = 0.96), whereas positive remodeling was directly proportional to the volumetric growth of the intima (r = 0.85, p < 0.001).ConclusionRoutine induction therapy with basiliximab was associated with reduced growth of the intima of the vessel during the first year after HT.

Risk stratification to determine the impact of induction therapy on survival, rejection and adverse events after pediatric heart transplant: A multi-institutional study

“…Adult studies have identified reduced intravascular ultrasound (IVUS) changes within the first year post-transplant in patients who received ALA or IL-2RA compared with those who received NI; however, IVUS data are only available for 2% of the CMP and 5.3% of the CHD patients, most likely due to the technical limitations of applicability in the pediatric population. 20,21 Likewise, the incidence of PTLD was not higher in patients receiving either induction therapy. This dispels one of the major concerns about the general use of ALA in children and is in concordance with findings from other studies that did not show a correlation between induction and the risk of PTLD.…”

Coronary artery disease in heart transplantation: new concepts for an old disease

“…Use of antithymocyte globulins (ATG) was associated with less IVUS‐detected CAV in a study including 103 patients, 1 year after transplantation. Similarly, but in a study including just 13 patients , basiliximab was as well found associated with less IVUS‐defined CAV progression. In the past, other studies found that ATG is associated with less CAV progression, providing substantial evidence in support of this effect .…”

“…Most of studies (58%) investigated the effect of mTOR inhibitors (sirolimus or everolimus) in comparison with calcineurin inhibitors (CNIs, cyclosporin or tacrolimus) or to mycophenolate derivatives (MMF) [74,[76][77][78][79][80][82][83][84][85][86]. The other agents investigated for CAV prevention included induction therapies, tacrolimus versus cyclosporine, Ace inhibitors, aspirin, statins and granulocyte-colony-stimulating factor [73,75,81, [87][88][89][90][91][92][93].…”

Outcomes of Induction Therapy with Rabbit Anti-Thymocyte Globulin in Heart Transplant Recipients: A Single Center Retrospective Cohort Study

“…There is good evidence that rATG induction with reduced exposure to CNI and steroids will provide similar efficacy to a conventional CNI regimen [ 16 , 17 ]. Another known benefit is that the induction with rATG lowers the incidence of angiographic cardiac allograft vasculopathy [ 18 , 19 ].…”