Thorac Cardiovasc Surg 2021; 69(S 02): S93-S117
DOI: 10.1055/s-0041-1725893
Oral Presentations
Saturday, February 27
Terminale Herzinsuffizienz: klinische und prä-klinische Aspekte

Long-Term Follow-up of Calcineurin Inhibitor-Free Immunosuppression in Pediatric Heart Transplantation Recipients

L. M. Rosenthal
1   Berlin, Deutschland
,
V. Lorenzen
1   Berlin, Deutschland
,
F. Danne
1   Berlin, Deutschland
,
K. Schmitt
1   Berlin, Deutschland
,
O. Miera
1   Berlin, Deutschland
,
F. Berger
1   Berlin, Deutschland
,
S. Schubert
1   Berlin, Deutschland
› Author Affiliations

Objectives: Calcineurin inhibitors (CNI) remain the most effective class of immunosuppressors and significantly contributed to the progress in graft survival rates in solid organ transplantation. However, continuous use of CNI may result in renal toxicity and an increased risk for malignancies including posttransplant lymphoproliferative disease (PTLD). Discontinuation of CNIs in immunosuppression (IS) has been demonstrated to be safe in adult heart transplantation recipients. However the experience regarding tolerability, safety and effect on renal function in children is very limited. The aim of this study was to assess the safety of long-term CNI-free immunosuppression with regard to survival, graft failure, and the impact on renal function.

Methods: A single-center retrospective analysis was performed. Patients discontinued on CNI were maintained on mycophenolate mofetil (MMF) and everolimus without the use of corticosteroids. Rejection surveillance was performed with annual catheterization for evaluation of hemodynamics and endomyocardial biopsy (EMB). Serum creatinine levels and estimated glomerular filtration rates were analyzed to assess renal function.

Result: Fifteen patients were identified to be discontinued on CNI in our institution. The median follow-up time after switch of IS was 6 years (range: 0–11 years). CNI was discontinued after a median time of 9 years (range: 3–14 years). Median survival time after transplantation was 15 years (range: 5–23 years). One patient died of acute humoral rejection 15 years after transplantation, the other 14 patients are alive with good graft function. No increased rejection rate could be observed after discontinuation of CNI. Serum creatinine levels significantly decreased and estimated glomerular filtration significantly increased.

Conclusion: CNI discontinued maintenance therapy appears to be safe in pediatric heart transplant recipients with no increased risk of rejection or death and leads to significant recovery of impaired renal function.



Publication History

Article published online:
21 February 2021

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