Superior prevention of acute rejection by tacrolimus vs. cyclosporine in heart transplant recipients - A large European trial

M. Grimm, M. Rinaldi, N. A. Yonan, G. Arpesella, J. M. Arizón Del Prado, L. A. Pulpón, J. P. Villemot, M. Frigerio, J. L. Rodriguez Lambert, M. G. Crespo-Leiro, L. Almenar, D. Duveau, A. Ordonez-Fernandez, J. Gandjbakhch, M. Maccherini, G. Laufer

    Research output: Contribution to journalArticlepeer-review

    Abstract

    We compared efficacy and safety of tacrolimus (Tac)-based vs. cyclosporine (CyA) microemulsion-based immunosuppression in combination with azathioprine (Aza) and corticosteroids in heart transplant recipients. During antibody induction, patients were randomized (1:1) to oral treatment with Tac or CyA. Episodes of acute rejection were assessed by protocol biopsies, which underwent local and blinded central evaluation. The full analysis set comprised 157 patients per group. Patient/graft survival was 92.9% for Tac and 89.8% for CyA at 18 months. The primary end point, incidence of first biopsy proven acute rejection (BPAR) of grade ≥ 1B at month 6, was 54.0% for Tac vs. 66.4% for CyA (p = 0.029) according to central assessment. Also, incidence of first BPAR of grade ≥ 3A at month 6 was significantly lower for Tac vs. CyA; 28.0% vs. 42.0%, respectively (p = 0.013). Significant differences (p <0.05) emerged between groups for these clinically relevant adverse events: new-onset diabetes mellitus (20.3% vs. 10.5%); post-transplant arterial hypertension (65.6% vs. 77.7%); and dyslipidemia (28.7% vs. 40.1%) for Tac vs. CyA, respectively. Incidence and pattern of infections over 18 months were comparable between groups, as was renal function. Primary use of Tac during antibody induction resulted in superior prevention of acute rejection without an associated increase in infections. © 2006 The Authors.
    Original languageEnglish
    Pages (from-to)1387-1397
    Number of pages10
    JournalAmerican Journal of Transplantation
    Volume6
    Issue number6
    DOIs
    Publication statusPublished - Jun 2006

    Keywords

    • Acute rejection
    • Cyclosporine
    • Heart transplantation
    • Hyperlipidemia
    • Hypertension
    • Tacrolimus

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