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ABSTRACT: Everolimus has been prescribed both for initial and maintenance therapy after cardiac transplantation. Herein, we present our initial experience with everolimus as maintenance therapy after cardiac transplantation.
We retrospectively included all of our patients in whom therapy was changed from calcineurin inhibitors to everolimus between September 2006 and October 2007. We analyzed their baseline clinical characteristics, indications for conversion to everolimus therapy, and beneficial vs adverse effects of the maneuver.
In 16 heart transplant recipients, therapy was changed to everolimus because of allograft vasculopathy (n = 8), renal failure (n = 4), or sirolimus toxicity (n = 4). Treatment with everolimus was initiated at a mean (SD) of 79.8 (52.7) months (range, 10-163 mo) after transplantation. The initial dose was 1.4 (0.2) mg (range, 1.0-1.5 mg), and the maintenance dose was 1 (0.31) mg (range, 0.5-1.5 mg). Follow-up was 7.28 (3.22) months (range, 0.5-13 mo). Observed side effects included hypertriglyceridemia, hypertension, and edema. Only 1 of 4 patients included because of sirolimus intolerance did not tolerate everolimus; renal dysfunction did not worsen in any of these 4 patients. No allograft vasculopathy was observed.
Renal function seem to stabilize after conversion to everolimus therapy in patients with previous progressive dysfunction. The safety profile was proved in all patients, although conclusions cannot be established about the evolution of allograft vasculopathy.
Transplantation Proceedings 12/2008; 40(9):3046-8. · 1.00 Impact Factor
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M V Mogollón Jiménez,
J M Sobrino Márquez,
J M Arizón Muñoz, J A Sánchez Brotons,
A Guisado Rasco,
M M Hernández Jiménez,
N Romero Rodríguez,
J M Borrego Domínguez,
A Ordoñez Fernández,
E Lage Gallé,
A Martínez Martínez
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ABSTRACT: Diabetes mellitus is one of the main metabolic complications after heart transplantation. The aims of our study were to determine the incidence and factors that determine the appearance of posttransplantation diabetes mellitus (PTDM) and its prognostic value.
We performed a retrospective study of all heart transplant recipients in our hospital from January 1993 to December 2005, including 116 patients with prolonged monitoring with 59-month median follow-up. We divided the patients into two groups, according to whether they had de novo diabetes (group 1) or no diabetes (group 2).
Patients with PTDM were significantly older, with a median difference (MD) of 5.4 years (95% confidence interval [CI], 1.53-9.28) and a greater body mass index (MD, 3.37 kg/m(2); 95% CI, 1.68-5.06). Moreover, a greater percentage of patients in group 1 had ischemia compared to other etiologies. However, no significant differences were observed regarding other cardiovascular risk factors. PTDM was associated with a greater incidence of posttransplant hypertension (51.6% in group 1 vs 48.4% in group 2, P = .08) and posttransplant renal failure (59.5% in group 1 vs 40.5% in group 2, P = .001). However, no differences were observed in overall survival.
Age, overweight, and ischemic origin of cardiopathy were the main risk factors for the development of PTDM in our population. Although no differences were observed in survival rates, PTDM was associated with a greater incidence of hypertension and renal insufficiency, which may have long-term influences on patient survival.
Transplantation Proceedings 12/2008; 40(9):3053-5. · 1.00 Impact Factor
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ABSTRACT: To evaluate the safety and efficacy of ezetimibe in a sample of transplanted cardiac patients.
We undertook a descriptive retrospective observational study of 19 transplanted cardiac patients in whom treatment with ezetimibe was initiated at doses of 10 mg/d between 2004 and 2006, assessing tolerability and changes in lipid levels (total cholesterol and triglycerides), doses of immunosuppressive drugs, and the hepatic profile after 12 months of treatment.
There was no effect on the doses required of any immunosuppressive drugs. We observed a reduction in cholesterol levels, with a normal distribution (mean +/- standard deviation 26.84 +/- 14 mg/dL) among patients with ezetimibe addition, despite no change in the statin doses. There were no changes in the levels of triglycerides, transaminases, or bilirubin, and no cases of rhabdomyolysis or myalgia. All patients continued to take the drug after 1 year of treatment.
In our sample, the administration of ezetimibe to transplanted cardiac patients for 1 year was associated with a reduction in cholesterol levels by 26.8%. No substantial changes in the doses of immunosuppressive drugs could be attributed to the use of ezetimibe. Tolerance was good, with no need for drug withdrawal in any case.
Transplantation Proceedings 12/2008; 40(9):3058-9. · 1.00 Impact Factor
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M.V. Mogollón Jiménez,
J.M. Sobrino Márquez,
J.M. Arizón Muñoz, J.A. Sánchez Brotons,
A. Guisado Rasco,
M.M. Hernández Jiménez,
N. Romero Rodríguez,
J.M. Borrego Domínguez,
A. Ordoñez Fernández,
E. Lage Gallé,
Á. Martínez Martínez
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ABSTRACT: IntroductionDiabetes mellitus is one of the main metabolic complications after heart transplantation. The aims of our study were to determine the incidence and factors that determine the appearance of posttransplantation diabetes mellitus (PTDM) and its prognostic value.Materials and methodsWe performed a retrospective study of all heart transplant recipients in our hospital from January 1993 to December 2005, including 116 patients with prolonged monitoring with 59-month median follow-up. We divided the patients into two groups, according to whether they had de novo diabetes (group 1) or no diabetes (group 2).ResultsPatients with PTDM were significantly older, with a median difference (MD) of 5.4 years (95% confidence interval [CI], 1.53–9.28) and a greater body mass index (MD, 3.37 kg/m2; 95% CI, 1.68–5.06). Moreover, a greater percentage of patients in group 1 had ischemia compared to other etiologies. However, no significant differences were observed regarding other cardiovascular risk factors. PTDM was associated with a greater incidence of posttransplant hypertension (51.6% in group 1 vs 48.4% in group 2, P = .08) and posttransplant renal failure (59.5% in group 1 vs 40.5% in group 2, P = .001). However, no differences were observed in overall survival.ConclusionsAge, overweight, and ischemic origin of cardiopathy were the main risk factors for the development of PTDM in our population. Although no differences were observed in survival rates, PTDM was associated with a greater incidence of hypertension and renal insufficiency, which may have long-term influences on patient survival.
Transplantation Proceedings.
