Abstract 10802: Differential Effects of Everolimus on Early vs. Late Allograft Vasculopathy Progression in Heart Transplant Recipients: a Longitudinal IVUS-Based Study
Coronary allograft vasculopathy (CAV) is the main cause of graft failure after heart transplantation (HT). Clinical trials showed that everolimus (EVE) prevents early CAV. However, its effect in a clinical practice setting, and on long-term CAV progression in comparison with mycophenolate mofetil (MMF) is unexplored. By serial intra-vascular ultrasound (IVUS), we analyzed change of maximal intimal thickness (MIT) during the first post HT year (early cohort), and during the years 1 to 5 post HT (late cohort). In the early cohort, we compared MIT change of patients starting EVE within the sixth month after HT with patients receiving MMF during the entire 12 months period. In the late cohort, we compared year 1 to 5 MIT change of patients starting EVE at least 2.5 years prior to the year 5 IVUS with patients continuously receiving MMF. Among the 78 patients included in the early cohort, the 21 on EVE developed significantly less MIT increase than the 57 on MMF (0.22±0.14 vs. 0.37±0.30 mm; P=0.04), and lower rate of MIT change >0.5mm (5% vs. 19%; P=0.08). In the late cohort group, conversely, change in MIT in the 14 EVE patients did not differ from the 30 on MMF (0.38±0.10 vs. 0.30±0.07; P=0.7). Of note, demography, donor features, statin use, and cardiovascular risk factors were evenly distributed between EVE and MMF groups in both patients' cohorts. Besides the limitations of small sample size and lack of randomized design, this study shows that EVE started within the first 6 months after HT appears to reduce early coronary intimal hyperplasia in comparison with MMF, in a clinical practice setting. Conversely, late use of EVE does not appear to provide additional benefit on long-term MIT progression. While raising the hypothesis that different mechanisms may be involved in early and late CAV development, these results support the efficacy of EVE for CAV prevention but not for CAV treatment.
- © 2011 by American Heart Association, Inc.