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

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...

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Autores principales: Kampaktsis, Polydoros N., Doulamis, Ilias P., Asleh, Rabea, Makri, Elpiniki, Kalamaras, Ilias, Papastergiopoulos, Christoforos, Emfietzoglou, Maria, Drosou, Anastasis, Van den Eynde, Jef, Alnsasra, Hilmi, Duque, Ernesto Ruiz, Briasoulis, Alexandros
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9496402/
https://www.ncbi.nlm.nih.gov/pubmed/36000418
http://dx.doi.org/10.1161/JAHA.122.025507
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author Kampaktsis, Polydoros N.
Doulamis, Ilias P.
Asleh, Rabea
Makri, Elpiniki
Kalamaras, Ilias
Papastergiopoulos, Christoforos
Emfietzoglou, Maria
Drosou, Anastasis
Van den Eynde, Jef
Alnsasra, Hilmi
Duque, Ernesto Ruiz
Briasoulis, Alexandros
author_facet Kampaktsis, Polydoros N.
Doulamis, Ilias P.
Asleh, Rabea
Makri, Elpiniki
Kalamaras, Ilias
Papastergiopoulos, Christoforos
Emfietzoglou, Maria
Drosou, Anastasis
Van den Eynde, Jef
Alnsasra, Hilmi
Duque, Ernesto Ruiz
Briasoulis, Alexandros
author_sort Kampaktsis, Polydoros N.
collection PubMed
description 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.
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spelling pubmed-94964022022-09-30 Characteristics, Predictors, and Outcomes of Early mTOR Inhibitor Use After Heart Transplantation: Insights From the UNOS Database Kampaktsis, Polydoros N. Doulamis, Ilias P. Asleh, Rabea Makri, Elpiniki Kalamaras, Ilias Papastergiopoulos, Christoforos Emfietzoglou, Maria Drosou, Anastasis Van den Eynde, Jef Alnsasra, Hilmi Duque, Ernesto Ruiz Briasoulis, Alexandros J Am Heart Assoc Original Research 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. John Wiley and Sons Inc. 2022-08-24 /pmc/articles/PMC9496402/ /pubmed/36000418 http://dx.doi.org/10.1161/JAHA.122.025507 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Kampaktsis, Polydoros N.
Doulamis, Ilias P.
Asleh, Rabea
Makri, Elpiniki
Kalamaras, Ilias
Papastergiopoulos, Christoforos
Emfietzoglou, Maria
Drosou, Anastasis
Van den Eynde, Jef
Alnsasra, Hilmi
Duque, Ernesto Ruiz
Briasoulis, Alexandros
Characteristics, Predictors, and Outcomes of Early mTOR Inhibitor Use After Heart Transplantation: Insights From the UNOS Database
title Characteristics, Predictors, and Outcomes of Early mTOR Inhibitor Use After Heart Transplantation: Insights From the UNOS Database
title_full Characteristics, Predictors, and Outcomes of Early mTOR Inhibitor Use After Heart Transplantation: Insights From the UNOS Database
title_fullStr Characteristics, Predictors, and Outcomes of Early mTOR Inhibitor Use After Heart Transplantation: Insights From the UNOS Database
title_full_unstemmed Characteristics, Predictors, and Outcomes of Early mTOR Inhibitor Use After Heart Transplantation: Insights From the UNOS Database
title_short Characteristics, Predictors, and Outcomes of Early mTOR Inhibitor Use After Heart Transplantation: Insights From the UNOS Database
title_sort characteristics, predictors, and outcomes of early mtor inhibitor use after heart transplantation: insights from the unos database
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9496402/
https://www.ncbi.nlm.nih.gov/pubmed/36000418
http://dx.doi.org/10.1161/JAHA.122.025507
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