Conversion to everolimus in pediatric heart transplant recipients is a safe treatment option with an impact on cardiac allograft vasculopathy and renal function

Abstract

Background Cardiac allograft vasculopathy (CAV) and nephrotoxicity affect long‐term survival after heart transplantation (HTX). Studies, mostly conducted in adults, showed a positive effect of everolimus (EVL) on these problems. We describe the effects of conversion of the immunosuppressive therapy to an everolimus including regime on CAV, renal function, and safety in heart transplanted children/adolescents. Methods This retrospective single‐center study included 36 participants (mean time after HTX 6.3 ± 4.7 years). Descriptive pre/post‐comparisons were performed with an observation period partially up to 4 years. Impact on CAV was assessed based on intravascular imaging and Stanford grading. Safety analysis included cytomegalovirus (CMV)‐infection and acute rejection. Results In terms of CAV (9 out of 36 patients) four showed no progression, three an improvement, one a worsening; one new diagnosis. The average CrCl showed a significant improvement 6, 12, and 24 months after conversion regarding all patients (n = 29). There was no acute rejection or CMV‐infection. Conclusion Conversion to an EVL‐based therapy after pediatric HTX is a safe immunosuppressive regime without increasing risk of acute rejection or CMV‐infection. There was some evidence of reduction in progression of CAV and a significant improvement of the renal function.

Long‐term experience using CNI‐free immunosuppression in selected paediatric heart transplant recipients

“…Relapse after conversion to CNI-free IS 2 (22) Abbreviations: EBV, Epstein-Barr virus; IS, immunosuppression. a More than one option may apply to one patient.…”

“…17,18 Limited single-centre studies indicate that conversion to mTORis in combination with MMF may be a safe maintenance therapy without loss of efficacy and stabilisation of renal function in selected patients. 4,14,[19][20][21][22] However, an increased risk of acute rejection (21% vs. 6.8%) was reported in a randomised controlled trial of adult heart transplant patients receiving CNI-free immunosuppression vs. a CNIreduced regimen. 23 Therefore, this study aimed to evaluate the longterm therapeutic efficacy and safety of CNI-free immunosuppression in selected paediatric patients in terms of survival, graft function, renal function, development of malignancies and progression of CAV.…”