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30 April 2007
MedWire News: A novel immunosuppression regimen for heart transplant patients can improve kidney function and prevent transplant coronary heart disease, two studies have revealed.
Calcineurin inhibitors are a standard immunosuppressive therapy used to prevent allograft rejection, but the drugs are a major cause of kidney dysfunction and do nothing to prevent transplant coronary artery disease (CAD), a rapidly progressing form of coronary disease that often develops in heart transplant recipients.
¡°Immunosuppression for heart transplant patients using calcineurin inhibitors has been essentially unchanged for 25 years, and the results have not been ideal,¡± explained lead author Sudhir Kushwaha (Mayo Clinic, Rochester, Minnesota, USA).
¡°Five to 10 years post-transplant, 10% of patients are on dialysis or need a kidney transplant. And 10 years post-transplant, 50% of patients are either waiting for another heart transplant because of CAD or have died as a result of it.¡±
Kushwaha and colleagues tested the use of sirolimus as an alternative anti-proliferative immunosuppressant drug. In one study, 78 stable heart transplant patients who were gradually transferred from calceurin inhibitors onto sirolimus showed improvements in glomerular filtration rates and creatinine clearance, with no difference in cardiac rejection compared with 51 patients maintained on calcineurin inhibitors.
In another study, 29 stable patients who underwent the gradual transition onto sirolimus had significantly impaired progression of atherosclerotic changes found in transplant CAD.
Compared with 40 control patients who were maintained on calcineurin inhibitors, those who converted to sirolimus had significantly smaller increases in atherosclerotic plaque volume and index in the first 2 years after transplantation. Beyond 2 years, the increase in plaque volume, but not plaque index, was significantly lower with sirolimus than calcineurin inhibitors.
¡°Based on our findings, patients should still receive calcineurin inhibitors as the primary immunosuppressant immediately after transplant, and the conversion to sirolimus must be gradual in order to prevent rejection,¡± said Kushwaha. ¡°Today, standard practice at Mayo Clinic is to consider converting all heart transplant patients from calcineurin inhibitors to sirolimus at 6 months post-transplant if there are contraindications.¡±
The results were presented at the International Society for Heart and Lung Transplantation Annual Meeting and Scientific Sessions in San Francisco, California, USA.
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MedWire News: A novel immunosuppression regimen for heart transplant patients can improve kidney function and prevent transplant coronary heart disease, two studies have revealed.
Calcineurin inhibitors are a standard immunosuppressive therapy used to prevent allograft rejection, but the drugs are a major cause of kidney dysfunction and do nothing to prevent transplant coronary artery disease (CAD), a rapidly progressing form of coronary disease that often develops in heart transplant recipients.
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作者:admin@医学,生命科学 2011-02-18 05:11
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