Abstract 16113: Calcineurin-Inhibitor Free Sirolimus-Based Immunosuppression in Pediatric Heart Transplant Recipients
Introduction: While calcineurin inhibitors (CNIs) have been the cornerstone of immunosuppression in heart transplant patients, they are nephrotoxic and are not efficacious for cardiac allograft vasculopathy (CAV). There are limited data on CNI-free immunosuppression in pediatric heart transplant (PHT) recipients.
Hypothesis: CNI free sirolimus-based immunosuppression in PHT is safe, efficacious, and associated with improved renal function.
Methods: A retrospective review at our institution to evaluate efficacy and side effect profile of sirolimus used with or without an antimetabolite in the absence of CNI was performed for PHT patients undergoing conversion from CNI to sirolimus between 2002 and 2010.
Results: 17 PHT recipients underwent transplant at a median age of 1.2 years [interquartile range (IQR) 0.2 to 4.3) were changed to sirolimus and discontinued from CNIs between 2002 and 2010 at a median time of 5.7 years (IQR 2.2 to12.8) after transplant. Reasons for change were renal dysfunction in 11 patients, post-transplant lymphoproliferative disorder (PTLD) in 5 patients, and CAV in 1 patient. All patients are alive without retransplant at a median of 2.8 years (IQR 2.4 to 6.3) after the change. Complete data are available in 16 patients 1 year before and after change, and in 13 patients 2 year before and after. BUN decreased at 1 and 2 year post-CNI discontinuation and other parameters of renal function were stable (Table). There was 1 episode of rejection within the year before, and 4 episodes in 4 patients in the year after the change (p=0.25). There was 1 new diagnosis of CAV, no progression in the 3 patient with existing CAV, and no new cases of PTLD.
Conclusions: CNI-free sirolumus-based immunosuppression is possible in PHT recipients. In this small cohort, there was no decrement in renal function or progression of CAV. These patients require surveillance for acute rejection, and further study in larger cohorts is needed to assess for longer term outcomes.
- © 2012 by American Heart Association, Inc.