RT Journal Article
T1 Impact of intrapatient blood level variability of calcineurin inhibitors on heart transplant outcomes.
A1 González-Vílchez, Francisco
A1 Crespo-Leiro, María G
A1 Delgado-Jiménez, Juan
A1 Pérez-Villa, Félix
A1 Segovia-Cubero, Javier
A1 Díaz-Molina, Beatriz
A1 Mirabet-Pérez, Sonia
A1 Arizón Del Prado, José María
A1 Blasco-Peiró, Teresa
A1 Martínez-Sellés, Manuel
A1 Almenar-Bonet, Luis
A1 Garrido-Bravo, Iris
A1 Rábago, Gregorio
A1 Vázquez de Prada, José Antonio
K1 Blood levels
K1 Calcineurin inhibitors
K1 Coefficient of variation
K1 Coeficiente de variación
K1 Concentración sanguínea
K1 Heart transplant
K1 Inhibidores de la calcineurina
K1 Trasplante cardiaco
K1 Variabilidad
K1 Variability
AB 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.
YR 2021
FD 2021-03-18
LK http://hdl.handle.net/10668/22490
UL http://hdl.handle.net/10668/22490
LA en
LA es
DS RISalud
RD Apr 11, 2025