%0 Journal Article
%A González-Vílchez, Francisco
%A Crespo-Leiro, María G
%A Delgado-Jiménez, Juan
%A Pérez-Villa, Félix
%A Segovia-Cubero, Javier
%A Díaz-Molina, Beatriz
%A Mirabet-Pérez, Sonia
%A Arizón Del Prado, José María
%A Blasco-Peiró, Teresa
%A Martínez-Sellés, Manuel
%A Almenar-Bonet, Luis
%A Garrido-Bravo, Iris
%A Rábago, Gregorio
%A Vázquez de Prada, José Antonio
%T Impact of intrapatient blood level variability of calcineurin inhibitors on heart transplant outcomes.
%D 2021
%U http://hdl.handle.net/10668/22490
%X Intrapatient blood level variability (IPV) of calcineurin inhibitors has been associated with poor outcomes in solid-organ transplant, but data for heart transplant are scarce. Our purpose was to ascertain the clinical impact of IPV in a multi-institutional cohort of heart transplant recipients. We retrospectively studied patients aged ≥18 years, with a first heart transplant performed between 2000 and 2014 and surviving≥ 1 year. IPV was assessed by the coefficient of variation of trough levels from posttransplant months 4 to 12. A composite of rejection or mortality/graft loss or rejection and all-cause mortality/graft loss between years 1 to 5 posttransplant were analyzed by Cox regression analysis. The study group consisted of 1581 recipients (median age, 56 years; women, 21%). Cyclosporine immediate-release tacrolimus and prolonged-release tacrolimus were used in 790, 527 and 264 patients, respectively. On multivariable analysis, coefficient of variation> 27.8% showed a nonsignificant trend to association with 5-year rejection-free survival (HR, 1.298; 95%CI, 0.993-1.695; P=.056) and with 5-year mortality (HR, 1.387; 95%CI, 0.979-1.963; P=.065). Association with rejection became significant on analysis of only those patients without rejection episodes during the first year posttransplant (HR, 1.609; 95%CI, 1.129-2.295; P=.011). The tacrolimus-based formulation had less IPV than cyclosporine and better results with less influence of IPV. IPV of calcineurin inhibitors is only marginally associated with mid-term outcomes after heart transplant, particularly with the tacrolimus-based immunosuppression, although it could play a role in the most stable recipients.
%K Blood levels
%K Calcineurin inhibitors
%K Coefficient of variation
%K Coeficiente de variación
%K Concentración sanguínea
%K Heart transplant
%K Inhibidores de la calcineurina
%K Trasplante cardiaco
%K Variabilidad
%K Variability
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