Characteristics, Predictors, and Outcomes of Early mTOR Inhibitor Use After Heart Transplantation: Insights From the UNOS Database

Polydoros N. Kampaktsis, Ilias P. Doulamis, Rabea Asleh, Elpiniki Makri, Ilias Kalamaras, Christoforos Papastergiopoulos, Maria Emfietzoglou, Anastasis Drosou, Hilmi Alnsasra, Ernesto Ruiz Duque, Alexandros Briasoulis

Research output: Contribution to journalArticlepeer-review


BACKGROUND: The clinical characteristics of mTOR (mammalian target of rapamycin) inhibitors use in heart transplant recipients and their outcomes have not been well described. METHODS AND RESULTS: We compared patients who received mTOR inhibitors within the first 2 years after heart transplantation to patients who did not by inquiring the United Network for Organ Sharing (UNOS) database between 2010 and 2018. The primary end point was all-cause mortality with retransplantation as a competing event. Rejection, malignancy, hospitalization for infection, and renal transplantation were secondary end points. There were 1619 (9%) and 15 686 (81%) mTOR inhibitors+ and mTOR inhibitors− patients, respectively. Body mass index, induction, cardiac allograft vasculopathy, calculated panel reactive antibody, and fewer days in 1A status were independently associated with mTOR inhibitors+ status. Over a follow-up of 10.4 years, there was no difference in all-cause mortality after adjusting for donor and recipient characteristics (adjusted subdistribution hazard ratio, 1.03 [0.90–1.19]; P=0.66). mTOR inhibitors+ were independently associated with increased risk for rejection (odds ratio [OR], 1.43 [1.11–1.83]; P=0.005) and basal skin cancer (OR, 1.35 [1.19–1.51]; P=0.012) but not for infection or renal transplantation. CONCLUSIONS: mTOR inhibitors are used in <10% patients in the first 2 years after heart transplantation and are noninferior to contemporary immunosuppression regimens in terms of all-cause mortality, infection, malignancy, or renal transplantation. They are associated with risk for rejection.

Original languageEnglish
Article numbere025507
JournalJournal of the American Heart Association
Issue number17
StatePublished - 6 Sep 2022
Externally publishedYes


  • heart transplantation
  • immunosuppression
  • motor inhibitors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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