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Journal article
Sirolimus Conversion After Heart Transplant: Risk Factors for Acute Rejection and Predictors of Renal Function Response
American journal of transplantation, v 14(9), pp 2048-2054
01 Sep 2014
PMID: 25307036
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
In a randomized, comparative study of cardiac transplant patients with mild-to-moderate renal insufficiency, conversion from calcineurin inhibitors (CNIs) to sirolimus improved renal function at 1 year versus continuing CNIs, with an attendant risk of biopsy-confirmed acute rejection (BCAR). Posthoc analyseswere conducted to identify predictors of BCAR and GFR improvement associated with conversion. Patients with proteinuria >500mg/day were excluded. Univariate and multivariate regression analyses tested 13 parameters for BCAR and six for GFR improvement. In 57 sirolimus-treated patients, mean daily mycophenolate mofetil (MMF) dose was lower in those with versus without BCAR (1000 vs. 1420mg; p = 0.014). Receiver operating characteristic analysis identified MMF dose <= 1000mg/day as the optimal cutoff to predict BCAR. Multivariate analysis confirmed low MMF dose (odds ratio: 9.94; p = 0.007) and non-white race (odds ratio: 15.3; p = 0.06) were independently associated withBCAR. GFR improvementwas evaluated in intent-totreat patients (n = 116). Significant interaction was detected between treatment effect and preexisting diabetes status (univariate p = 0.077; multivariate p = 0.022), indicating greater beneficial effect of sirolimus in those without preexisting diabetes. These findings suggest that sirolimus is more effective in improving GFR in patients without preexisting diabetes, and adequate MMF doses are needed for sirolimus conversion.
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Details
- Title
- Sirolimus Conversion After Heart Transplant: Risk Factors for Acute Rejection and Predictors of Renal Function Response
- Creators
- A. Zuckermann - Arbeitsgemeinschaft für Klinische ErnährungH. Eisen - Drexel UniversityS. See Tai - Wyeth Pharmaceuticals (now Pfizer); Collegeville PAH. Li - Wyeth Pharmaceuticals (now Pfizer); Collegeville PAC. Hahn - Wyeth Pharmaceuticals (now Pfizer); Collegeville PAM. G. Crespo-Leiro - Complexo Hospitalario Universitario A Coruña
- Publication Details
- American journal of transplantation, v 14(9), pp 2048-2054
- Publisher
- Wiley
- Number of pages
- 7
- Grant note
- Pfizer Wyeth Pharmaceuticals; Wyeth
- Resource Type
- Journal article
- Language
- English
- Web of Science ID
- WOS:000342664000015
- Scopus ID
- 2-s2.0-84906275215
- Other Identifier
- 991019335240804721
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- Collaboration types
- Industry collaboration
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Surgery
- Transplantation