Sirolimus-Based Immunosuppression After Cardiac Transplantation: Predictors of Recovery From Calcineurin Inhibitor-Induced Renal Dysfunction

Sirolimus Conversion After Heart Transplant: Risk Factors for Acute Rejection and Predictors of Renal Function Response

“…In a cohort of 38 patients who started sirolimus while concomitantly lowering or discontinuing CNI therapy, time since transplantation and renal function at 3 months before conversion were associated with renal function improvement at 1 month. Diabetes was not identified as an independent predictor (35). Differences across studies in predictive factors should take into account the time frame at which renal function improvement was assessed-at 1 year in the present study compared with 1 or 6 months in these other studies.…”

Everolimus Initiation and Early Calcineurin Inhibitor Withdrawal in Heart Transplant Recipients: A Randomized Trial

“…In contrast, the current study used everolimus to permit total CNI elimination in de novo heart transplant recipients and showed a marked improvement in mGFR after 12 months. Total CNI elimination avoids any direct detrimental effect of mTOR inhibition on renal podocytes secondary to CNI therapy (24,25). Furthermore, deterioration of renal function is particularly rapid in the first few months after heart transplantation (26,27).…”

Avoidance of Calcineurin Inhibitors With Use of Proliferation Signal Inhibitors in De Novo Heart Transplantation With Renal Failure

“…First used in the chronic heart failure setting as a substitute for CNI, they showed an adequate anti-rejection effect, an amelioration of renal dysfunction, and attenuation of the progression of vascular graft disease. 3,[5][6][7][8][9]11,12 Recent trials have established the efficacy and safety of both sirolimus 1,10 and everolimus 2 in de novo heart transplantation compared with MMF or azathioprine. In all these studies, however, PSIs were combined with CNIs.…”

“…[1][2][3][4] Use of PSIs in heart transplantation has been proposed in 2 different settings: (1) the chronic, stable patient with nephrotoxicity, allograft vasculopathy, or malignancies, and (2) in the acute de novo setting. In heart recipients with chronic disease, the conversion to a PSI in place of a calcineurin inhibitor (CNI) has prevented and eventually reversed CNI-induced renal failure, with no apparent increase in late rejection rates, [5][6][7][8][9] and might attenuate the progression of cardiac allograft vasculopathy. 3 In the acute setting, most experience with PSI for de novo immunosuppression comes from the combined use of PSIs and CNIs.…”