在心脏移植受者维持治疗中，霉酚酸酯转换为依维莫司对心脏移植血管病变发展的抑制作用。

Suppressive effects of conversion from mycophenolate mofetil to everolimus for the development of cardiac allograft vasculopathy in maintenance of heart transplant recipients.

作者信息

Watanabe Takuya, Seguchi Osamu, Nishimura Kunihiro, Fujita Tomoyuki, Murata Yoshihiro, Yanase Masanobu, Sato Takuma, Sunami Haruki, Nakajima Seiko, Hisamatsu Eriko, Sato Takamasa, Kuroda Kensuke, Hieda Michinari, Wada Kyoichi, Hata Hiroki, Ishibashi-Ueda Hatsue, Miyamoto Yoshihiro, Fukushima Norihide, Kobayashi Junjiro, Nakatani Takeshi

机构信息

Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.

Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.

出版信息

Int J Cardiol. 2016 Jan 15;203:307-14. doi: 10.1016/j.ijcard.2015.10.082. Epub 2015 Oct 23.

DOI:10.1016/j.ijcard.2015.10.082

PMID:26523360

Abstract

BACKGROUND

Whether converting to everolimus (EVL) from mycophenolate mofetil (MMF) during the maintenance period after heart transplantation (HTx) reduces cardiac allograft vasculopathy (CAV) progression remains unclear. We sought to determine the effect of converting from MMF with standard-dose calcineurin inhibitors (CNIs) to EVL with low-dose CNIs on CAV progression.

METHODS

We retrospectively reviewed the medical records of 63 HTx recipients who survived at least at 1 year after HTx. Twenty-four recipients were converted from MMF to EVL (EVL group, 2.2 ± 2.3 years after HTx), while 39 recipients were maintained on MMF (MMF group, 2.4 ± 2.2 years after HTx). The EVL group underwent three-dimensional intravascular ultrasound (3D-IVUS) analysis before and 1 year after conversion to EVL, and these data were compared with data from 2 consecutive IVUS in the MMF group.

RESULTS

IVUS indices in the EVL group at 1 year after conversion did not show increased CAV development, whereas a significant increase in %plaque volume (p=0.006) and decrease in lumen volume (p<0.001) were observed in the MMF group. EVL conversion was significantly associated with smaller increases in %plaque volume (p=0.004) and smaller decreases in lumen volume (p=0.017). IVUS indices in the late EVL conversion group (≥ 2 years) also did not exhibit increased CAV development, while those in the MMF group did.

CONCLUSIONS

Conversion to EVL from MMF in maintenance periods after HTx may decrease the rate of CAV progression based on IVUS indices.

摘要

背景

心脏移植（HTx）后维持期从霉酚酸酯（MMF）转换为依维莫司（EVL）是否能降低心脏移植血管病变（CAV）的进展尚不清楚。我们试图确定从使用标准剂量钙调神经磷酸酶抑制剂（CNIs）的MMF转换为使用低剂量CNIs的EVL对CAV进展的影响。

方法

我们回顾性分析了63例HTx术后至少存活1年的受者的病历。24例受者从MMF转换为EVL（EVL组，HTx术后2.2±2.3年），而39例受者继续使用MMF（MMF组，HTx术后2.4±2.2年）。EVL组在转换为EVL之前和之后进行了三维血管内超声（3D-IVUS）分析，并将这些数据与MMF组连续2次IVUS的数据进行比较。

结果

EVL组转换后1年的IVUS指标未显示CAV进展增加，而MMF组观察到斑块体积百分比显著增加（p=0.006）和管腔体积减小（p<0.001）。EVL转换与斑块体积百分比的较小增加（p=0.004）和管腔体积的较小减小（p=0.017）显著相关。晚期EVL转换组（≥2年）的IVUS指标也未显示CAV进展增加，而MMF组则显示增加。