Advancing Immunosuppression Therapy to Counter the Progression of Cardiac Allograft Vasculopathy

Mycophenolate Mofetil and Atherosclerosis

“…When an interventional crossover design was performed with 17 patients in each treatment arm, El-Sayed et al did find that coronary vessel occlusion was reduced by MMFrelative to azathioprine-treated patients, the MMF group showed a 21% decrease (or a 6% absolute decrease) in luminal occlusion. 46 The most recent retrospective study to examine this question was that of Kaczmarek et al, wherein angiographic assessments found 20% more patients were free from cardiac allograft vasculopathy when MMF-treated groups were compared to those not receiving MMF as part of their regimen. 47 A previous retrospective study had also found a 20% decrease in cardiovascular mortality among MMFtreated diabetic patients receiving renal transplants, compared with those on regimens not containing MMF.…”

“…Despite this, there was no reduction in total mortality or graft vasculopathy. When an interventional crossover design was performed with 17 patients in each treatment arm, El‐Sayed et al did find that coronary vessel occlusion was reduced by MMF‐ relative to azathioprine‐treated patients, the MMF group showed a 21% decrease (or a 6% absolute decrease) in luminal occlusion 46 . The most recent retrospective study to examine this question was that of Kaczmarek et al, wherein angiographic assessments found 20% more patients were free from cardiac allograft vasculopathy when MMF‐treated groups were compared to those not receiving MMF as part of their regimen 47 .…”

Duration of corticosteroid use and long‐term outcomes after adult heart transplantation: A contemporary analysis of the International Society for Heart and Lung Transplantation Registry

“…We did not observe association of CS length of use and the development of CAV. The effects of CS on progression of CAV remain controversial . While CS withdrawal may result in a decreased immunosuppression level, CS continuation may increase cardiovascular risk through higher risk of hypertension, dyslipidemia, and diabetes.…”

Reply to Mishra

“…Besides, what is the usual protocol for angiography in their post-transplant patients? Some centres have abandoned annual surveillance angiography and rely on radionuclide studies and angiography is performed only if the patient is symptomatic or noninvasive reports are suspicious [5]. Were the patients included in this study picked up by routine surveillance angiography or was the angiography indicated because of patient's symptoms?…”

“…The last point of argument relates to the definition of CAV used in this study and to the implications this might induce concerning appropriate treatment. Indeed, as specified we focussed on high grade lesions according to the Gao et al's classification [4] which are believed to be the most characteristic lesions of CAV and which are actually the main target of new immunosuppressive protocols [5]. In our experience, proximal, focal lesions accessible to angioplasty occur early after transplantation and are mainly a consequence of preexisting classical atherosclerosis and of post-transplant hypercholesterolemia.…”