Abstract 2580: Low Risk of Significant Rejection after Cardiac Transplantation Beyond the First Post-transplant Year in Patients Treated with Tacrolimus Based Immunosuppression
Purpose: Tacrolimus based immunosuppressive for cardiac transplantation (CTX) is highly effective. However long-term the incidence of significant rejection (SR), >= ISHLT grade 3A, beyond the first post-transplant year with tacrolimus based immunosuppression is uncertain.
Procedures: We performed a retrospective review of all biopsies through 12/31/04 performed on patients who received CTX from 1995 through 2004 at our institution who survived > 30 days and were immunosuppressed with tacrolimus.
Results: A total of 275 patients met inclusion criteria (mean age 53 years, male 72%, white 88%, ischemic cardiomyopathy 49%). Donor characteristics: mean age 34 years, male 66%, white 89%, mean ischemic time 186 minutes, CMV mismatch (D+/R-) 15%. Induction therapy was given in 23 (8.4%) and consisted of alemtuzumab in 2 (8.7%), OKT3 in 1 (4.4%), antithymocyte globulin in 10 (44%), and daclizumab in 10 (44%). Mean follow-up was 4.4 years and a total of 4873 biopsies were performed, 23% of which were performed >= 3 years post-CTX. At 1, 2, 3, 4, and 5–10 years post-CTX mean tacrolimus levels (ng/mL) were: 14.3, 11.7, 11.0, 11.1, and 9.1. The incidence of SR per patient in the first post-TX year was 47.3%. For years 2, 3, 4 and 5–10 the incidence of SR per patient was: 4.0%, 4.6%, 3.0%, and 1.5%. There were no significant differences in the incidence of SR per patient in any year post-CTX between those who did and did not receive induction.
Conclusions: In a high-risk population, the incidence of SR per patient remains substantial in the first post-CTX year using tacrolimus based immunosuppression, however the rate of rejection per patient decreases substantially in the second year post-CTX and remains low in subsequent years. Tacrolimus based immunosuppression post-CTX is a highly effective long-term immunosuppressive strategy.