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. 2021 Dec;25(8):e14111.
doi: 10.1111/petr.14111. Epub 2021 Aug 18.

Long-term experience using CNI-free immunosuppression in selected paediatric heart transplant recipients

Lisa-Maria Rosenthal  1   2 , Johannes Nordmeyer  1 , Peter Kramer  1 , Friederike Danne  1 , Constanze Pfitzer  1 , Felix Berger  1   2   3 , Katharina Rose Luise Schmitt  1   2   3 , Stephan Schubert  1   3   4
Affiliations

Long-term experience using CNI-free immunosuppression in selected paediatric heart transplant recipients

Lisa-Maria Rosenthal et al. Pediatr Transplant. 2021 Dec.

Abstract

Background: CNI-free immunosuppression with conversion to mTORi-based immunosuppression has been demonstrated to reduce CNI-toxicity and to exhibit anti-proliferative properties. However, the experience of CNI-free immunosuppression in paediatric heart transplantation is limited.

Methods: A retrospective analysis was conducted of 129 paediatric heart transplants performed between 1997 and 2015. Fifteen patients with clinically indicated conversion from CNI-based to CNI-free immunosuppression were identified. Survival data, rejection episodes, renal function, post-transplantation lymphoproliferative disorder and CAV, including examination with OCT were analysed.

Results: Immunosuppression conversion was successful in all patients. Fourteen of 15 patients (93%) are currently living with good graft function. Median post-transplant survival was 15 years (range, 5-23 years), and median follow-up since conversion was 6 years (range, 1-11 years). Mild (grade 1R) ACR was present in three patients after discontinuation of CNIs. The recovery of renal function with a significant increase in eGFR was observed at 1 and 3 years after conversion. No patient had angiographic signs of macroscopic CAV according to the current ISHLT classification; however, OCT showed the signs of angiographically silent CAV in all patients. CAV did not progress in any patient, implying CAV was stabilised by mTORi-based CNI-free immunosuppression.

Conclusions: CNI-free immunosuppression based on mTORis is a safe and appropriate strategy for maintenance therapy in selected paediatric patients, significantly improves renal function and stabilises CAV. OCT revealed early development of angiographically silent CAV.

Keywords: CAV; CNI-free immunosuppression; OCT; chronic kidney injury; pediatric heart transplantation.

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References

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