mTor‐inhibition within the first days after pediatric heart transplantation is a potentially safe option to prevent cardiac allograft vasculopathy

Background Immunosuppression after heart transplantation (HTX) with mammalian target of rapamycin (mTOR) inhibitors serves as a prophylaxis against rejection and to treat coronary vascular injury. However, there is little data on the early, preventive use of everolimus after pediatric HTX. Methods R...

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Bibliographic Details
Published in:Pediatric transplantation 2024-03, Vol.28 (2), p.e14698-n/a
Main Authors: Kreienbaum, Hannah, Stiller, Brigitte, Kubicki, Rouven, Bobrowski, Alexej, Kroll, Johannes, Fleck, Thilo
Format: Article
Language:English
Subjects:
Adolescent
Allografts
Calcineurin inhibitors
cardiac allograft vasculopathy
Cardiomyopathy
Child
Child, Preschool
Everolimus - therapeutic use
Female
Graft rejection
Heart
Heart diseases
Heart Injuries
Heart Transplantation
Heart transplants
Humans
Immunoproliferative diseases
Immunosuppression
immunosupression
Infant
Lymphocytes
Male
Mechanical properties
mTOR Inhibitor
Patients
pediatric heart transplantation
Pediatrics
Prophylaxis
Rapamycin
Renal failure
Renal function
Retrospective Studies
Risk factors
Survival
TOR protein
Vascular diseases
Wound healing
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Summary:Background Immunosuppression after heart transplantation (HTX) with mammalian target of rapamycin (mTOR) inhibitors serves as a prophylaxis against rejection and to treat coronary vascular injury. However, there is little data on the early, preventive use of everolimus after pediatric HTX. Methods Retrospective study of 61 pediatric HTX patients (48 cardiomyopathy and 13 congenital heart disease), 28 females, median age 10.1 (range 0.1–17.9) years transplanted between 2008 and 2020. We analyzed survival, rejection, renal function, occurrence of lymphoproliferative disorder, and allograft vasculopathy together with adverse effects of early everolimus therapy combined with low‐dose calcineurin inhibitors. Results Everolimus therapy was started at a median 3.9 (1–14) days after HTX. Median follow‐up was 4.3 (range 0.5–11.8) years, cumulative 184 patient years. The estimated 1‐ and 5‐year survival probability was 89% (CI 82%:98%) and 87% (CI 78%:97%). Four patients developed rejection (6.6%) (maximum 2R ISHLT criteria). No patient suffered from chronic renal failure. Three patients (4.9%) developed post‐transplant lymphoproliferative disorder. Five patients suffered relevant wound‐healing disorders after transplantation, four of them carrying relevant risk factors before HTX (mechanical circulatory support (n = 3), delayed chest closure after HTX (n = 3)). No recipient developed cardiac allograft vasculopathy. Conclusion Initiating everolimus within the first 14 days after HTX seems to be well tolerated, enabling a low incidence of rejection, post‐transplant lymphoproliferative disorders, renal failure, and reveals no evidence of cardiac allograft vasculopathy as well as good overall survival in pediatric heart transplant recipients. Initiating Everolimus therapy early after pediatric HTX seems to be a safe and effective option for immunosuppression, with no incidence of cardiac allograft vasculopathy and a low incidence in chronic renal failure.
ISSN:1397-3142
1399-3046
DOI:10.1111/petr.14698