High-dose calcineurin inhibitor-free everolimus as a maintenance regimen for heart transplantation may be a risk factor for Pneumocystis pneumonia

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Abstract

Background: Everolimus reduces the incidence of cardiac-allograft vasculopathy (CAV) and is less renally toxic than are calcineurin inhibitors (CNIs). We evaluated the safety of CNI-free everolimus for post-heart transplant (HTx) patients. Methods: We retrospectively reviewed the records of 36 consecutive patients who had undergone an HTx between January 2006 and December 2013 in National Cheng Kung University Hospital. All patients initially had been treated with the standard tacrolimus regimen. The Study group—12 patients with CAV, renal impairment, or a history of malignancy—were switched from tacrolimus to everolimus. The Control group consisted of 19 patients who remained on the standard regimen. The target everolimus trough concentration was 8-14 ng/mL. The primary outcome was survival, and the secondary outcomes were bacterial, viral, fungal, and other infections; Pneumocystis jirovecii pneumonia (PJP); and rejection (≥2R). Results: During a 53.3±25.6-month follow-up, the survival rate, rejection rate, and number of infections, except for PJP, were not significantly different between the two groups. In the Study group, 6 patients were diagnosed with PJP 33±18.2 months after switching. None of the Control group patients were diagnosed with PJP during follow-up. Conclusions: A high-dose CNI-free everolimus maintenance regimen might yield a higher incidence of post-transplantation PJP.

Original languageEnglish
Article numbere12709
JournalTransplant Infectious Disease
Volume19
Issue number4
DOIs
Publication statusPublished - 2017 Aug

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Pneumocystis Pneumonia
Heart Transplantation
Pneumocystis carinii
Maintenance
Tacrolimus
Allografts
Control Groups
Mycoses
Poisons
Incidence
Calcineurin Inhibitors
Everolimus
Survival Rate
Transplantation
Transplants
Kidney
Safety
Survival
Infection

All Science Journal Classification (ASJC) codes

  • Infectious Diseases
  • Transplantation

Cite this

@article{7ed114b87b2e4eb392c12ac9696ff887,
title = "High-dose calcineurin inhibitor-free everolimus as a maintenance regimen for heart transplantation may be a risk factor for Pneumocystis pneumonia",
abstract = "Background: Everolimus reduces the incidence of cardiac-allograft vasculopathy (CAV) and is less renally toxic than are calcineurin inhibitors (CNIs). We evaluated the safety of CNI-free everolimus for post-heart transplant (HTx) patients. Methods: We retrospectively reviewed the records of 36 consecutive patients who had undergone an HTx between January 2006 and December 2013 in National Cheng Kung University Hospital. All patients initially had been treated with the standard tacrolimus regimen. The Study group—12 patients with CAV, renal impairment, or a history of malignancy—were switched from tacrolimus to everolimus. The Control group consisted of 19 patients who remained on the standard regimen. The target everolimus trough concentration was 8-14 ng/mL. The primary outcome was survival, and the secondary outcomes were bacterial, viral, fungal, and other infections; Pneumocystis jirovecii pneumonia (PJP); and rejection (≥2R). Results: During a 53.3±25.6-month follow-up, the survival rate, rejection rate, and number of infections, except for PJP, were not significantly different between the two groups. In the Study group, 6 patients were diagnosed with PJP 33±18.2 months after switching. None of the Control group patients were diagnosed with PJP during follow-up. Conclusions: A high-dose CNI-free everolimus maintenance regimen might yield a higher incidence of post-transplantation PJP.",
author = "Hu, {Yu Ning} and Lee, {Nan Yao} and Roan, {Jun Neng} and Hsu, {Chi Hsin} and Luo, {Chwan Yau}",
year = "2017",
month = "8",
doi = "10.1111/tid.12709",
language = "English",
volume = "19",
journal = "Transplant Infectious Disease",
issn = "1398-2273",
publisher = "Wiley-Blackwell",
number = "4",

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T1 - High-dose calcineurin inhibitor-free everolimus as a maintenance regimen for heart transplantation may be a risk factor for Pneumocystis pneumonia

AU - Hu, Yu Ning

AU - Lee, Nan Yao

AU - Roan, Jun Neng

AU - Hsu, Chi Hsin

AU - Luo, Chwan Yau

PY - 2017/8

Y1 - 2017/8

N2 - Background: Everolimus reduces the incidence of cardiac-allograft vasculopathy (CAV) and is less renally toxic than are calcineurin inhibitors (CNIs). We evaluated the safety of CNI-free everolimus for post-heart transplant (HTx) patients. Methods: We retrospectively reviewed the records of 36 consecutive patients who had undergone an HTx between January 2006 and December 2013 in National Cheng Kung University Hospital. All patients initially had been treated with the standard tacrolimus regimen. The Study group—12 patients with CAV, renal impairment, or a history of malignancy—were switched from tacrolimus to everolimus. The Control group consisted of 19 patients who remained on the standard regimen. The target everolimus trough concentration was 8-14 ng/mL. The primary outcome was survival, and the secondary outcomes were bacterial, viral, fungal, and other infections; Pneumocystis jirovecii pneumonia (PJP); and rejection (≥2R). Results: During a 53.3±25.6-month follow-up, the survival rate, rejection rate, and number of infections, except for PJP, were not significantly different between the two groups. In the Study group, 6 patients were diagnosed with PJP 33±18.2 months after switching. None of the Control group patients were diagnosed with PJP during follow-up. Conclusions: A high-dose CNI-free everolimus maintenance regimen might yield a higher incidence of post-transplantation PJP.

AB - Background: Everolimus reduces the incidence of cardiac-allograft vasculopathy (CAV) and is less renally toxic than are calcineurin inhibitors (CNIs). We evaluated the safety of CNI-free everolimus for post-heart transplant (HTx) patients. Methods: We retrospectively reviewed the records of 36 consecutive patients who had undergone an HTx between January 2006 and December 2013 in National Cheng Kung University Hospital. All patients initially had been treated with the standard tacrolimus regimen. The Study group—12 patients with CAV, renal impairment, or a history of malignancy—were switched from tacrolimus to everolimus. The Control group consisted of 19 patients who remained on the standard regimen. The target everolimus trough concentration was 8-14 ng/mL. The primary outcome was survival, and the secondary outcomes were bacterial, viral, fungal, and other infections; Pneumocystis jirovecii pneumonia (PJP); and rejection (≥2R). Results: During a 53.3±25.6-month follow-up, the survival rate, rejection rate, and number of infections, except for PJP, were not significantly different between the two groups. In the Study group, 6 patients were diagnosed with PJP 33±18.2 months after switching. None of the Control group patients were diagnosed with PJP during follow-up. Conclusions: A high-dose CNI-free everolimus maintenance regimen might yield a higher incidence of post-transplantation PJP.

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