TY - JOUR
T1 - Characteristics, Predictors, and Outcomes of Early mTOR Inhibitor Use After Heart Transplantation
T2 - Insights From the UNOS Database
AU - Kampaktsis, Polydoros N.
AU - Doulamis, Ilias P.
AU - Asleh, Rabea
AU - Makri, Elpiniki
AU - Kalamaras, Ilias
AU - Papastergiopoulos, Christoforos
AU - Emfietzoglou, Maria
AU - Drosou, Anastasis
AU - Alnsasra, Hilmi
AU - Duque, Ernesto Ruiz
AU - Briasoulis, Alexandros
N1 - Publisher Copyright:
© 2022 The Authors.
PY - 2022/9/6
Y1 - 2022/9/6
N2 - 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.
AB - 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.
KW - heart transplantation
KW - immunosuppression
KW - motor inhibitors
UR - http://www.scopus.com/inward/record.url?scp=85137465544&partnerID=8YFLogxK
U2 - 10.1161/JAHA.122.025507
DO - 10.1161/JAHA.122.025507
M3 - Article
C2 - 36000418
AN - SCOPUS:85137465544
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 17
M1 - e025507
ER -