NDLI: Primary immunosuppression and outcome differences after heart transplantation: tacrolimus versus cyclosporine.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Castel, M. A. Farrero, M. Vallejos, I. Cardona, M. Regueiro, A. Pérez-Villa, F.
Spatial Coverage	Spain
Description	Country affiliation: Spain Author Affiliation: Castel MA ( Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.)
Abstract	BACKGROUND: The superiority of tacrolimus (Tac) as primary immunosuppression for heart transplantation (HT) compared with cyclosporine (CsA) is still under debate. Outcomes of comparison studies are not consistent; the duration of these studies has been limited. The aim of this study was to evaluate long-term outcomes of patients undergoing HT based on primary immunosuppression regime. METHODS AND RESULTS: We analyzed a single-center registry of all HT patients between 1998 and 2009, comparing outcomes based on primary immunosuppressions (Tac or CsA). Patients who died before starting immunosuppression were excluded. A total of 197 patients entered the study; 103 received Tac and 94 CsA. There were no differences between groups in baseline characteristics, United Network for Organ Sharing status 1A or ventricular assist device use, except for ischemia time (195 ± 50 min in Tac group vs 182 ± 55 min in CsA; P = .08) and days on waiting list (164 ± 155 vs 100 ± 73; P < .001). After mean follow-ups of 4.5 ± 2.3 years in the Tac group and 6.3 ± 4.3 years in the CsA group, there were 19 and 36 deaths, respectively. Kaplan-Meier analysis showed increased survival for the Tac group (log rank P = .04). Tac also was significantly superior to CsA regarding mortality (relative risk 0.55; 95% confidence interval, 0.31-0.98; P = .04). CONCLUSIONS: In our series the use of tacrolimus resulted in improved long-term survival compared with cyclosporine. At 1-year follow-up, there were no differences in acute rejection episodes or the appearance of vasculopathy.
File Format	HTM / HTML
ISSN	00411345
Issue Number	6
Volume Number	43
e-ISSN	18732623
Journal	Transplantation Proceedings
Language	English
Publisher	Elsevier
Publisher Date	2011-07-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Transplantation__semicolon__medicine Cyclosporine Therapeutic Use Graft Rejection Prevention & Control Graft Survival Drug Effects Heart Transplantation Immunosuppressive Agents Tacrolimus Adult Chi-square Distribution Drug Therapy, Combination Female Immunology Mortality Adverse Effects Humans Kaplan-meier Estimate Male Middle Aged Proportional Hazards Models Registries Retrospective Studies Risk Assessment Risk Factors Spain Survival Rate Time Factors Treatment Outcome Comparative Study Journal Article
Content Type	Text
Resource Type	Article
Subject	Transplantation Surgery

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