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von Scheidt W, Reichart B, Meiser B, von Scheidt M, Sen P, Schwarz F, Harmel E, Bengel FM, Dick A, Ueberfuhr P, Reichenspurner H, Jaeckel E, Schwinzer R, Hagl C. Unique 40-year survival after heart transplantation with normal graft function and spontaneous operational tolerance. Clin Res Cardiol 2024; 113:661-671. [PMID: 37982861 PMCID: PMC11026283 DOI: 10.1007/s00392-023-02341-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
Unique 40-year survival after heart transplantation with normal graft function and spontaneous operational tolerance.
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Affiliation(s)
- Wolfgang von Scheidt
- I.Medizinische Klinik, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Bruno Reichart
- Department of Cardiac Surgery, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bruno Meiser
- Transplant Center, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Partho Sen
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Florian Schwarz
- Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Eva Harmel
- I.Medizinische Klinik, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Andrea Dick
- Laboratory for Immunogenetics and Molecular Diagnostics, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Peter Ueberfuhr
- Department of Cardiac Surgery, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Elmar Jaeckel
- Ajmera Transplant Center, UHN, University of Toronto, Toronto, Canada
| | - Reinhard Schwinzer
- Department of General-, Visceral- and Transplantation-Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Alam A, van Zyl JS, Patel R, Jamil AK, Felius J, Carey SA, Gottlieb RL, Guerrero-Miranda CY, Kale P, Hall SA, Sam T. Three-year outcomes of de novo tacrolimus extended-release tablets (LCPT) compared to twice-daily tacrolimus in adult heart transplantation. Transpl Immunol 2024; 83:102009. [PMID: 38325525 DOI: 10.1016/j.trim.2024.102009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Extended-release tacrolimus for prophylaxis of allograft rejection in heart transplant (HT) recipients is currently not FDA-approved. One such extended-release formulation of tacrolimus known as LCPT allows once-daily dosing and improves bioavailability compared to immediate-release (IR-) tacrolimus. We compared long-term efficacy and safety of LCPT to IR-tacrolimus applied de novo in adult OHT recipients. METHODS 25 prospective recipients on LCPT at our center from 2017 to 2019 were matched 1:2 with historical control recipients treated with IR-tacrolimus based on age, gender, and baseline creatinine. The primary composite outcome of death, acute cellular rejection, and/or new graft dysfunction within 3 years following transplant was compared between groups using non-inferiority analysis. RESULTS LCPT demonstrated non-inferiority to IR-tacrolimus, with a primary outcome risk reduction of 16% (90%CI, -37%, -1%, non-inferiority p = 0.002) up to 3 years following heart transplant. Up to 3-years post-transplant, 14 patients remained on once-daily LCPT and 10 patients were switched to IR-tacrolimus due to lack of insurance coverage. There were no significant differences in the rate of chronic kidney disease requiring dialysis, cytomegalovirus requiring treatment, cardiac allograft vasculopathy, and malignancy within 3 years following transplant. CONCLUSION LCPT is non-inferior in efficacy to IR-tacrolimus in heart transplantation with a similar safety profile. Narrowly-constrained FDA labels specific to kidney transplant remain a barrier to consistent access to many immunosuppressant medications for recipients of non-kidney solid organs. We recommend the FDA consider developing facile pathways for expanding the approved label of extended-release tacrolimus formulations to heart transplant recipients.
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Affiliation(s)
- Amit Alam
- Division of Cardiology, New York University, New York City, NY, USA
| | - Johanna S van Zyl
- Texas A&M Health Science Center, Dallas, TX, USA; Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, TX, USA
| | - Raksha Patel
- Department of Pharmacy, Baylor University Medical Center, Dallas, TX, USA
| | - Aayla K Jamil
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, TX, USA
| | - Joost Felius
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, TX, USA
| | - Sandra A Carey
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA
| | - Robert L Gottlieb
- Texas A&M Health Science Center, Dallas, TX, USA; Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, TX, USA; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA; Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | - Cesar Y Guerrero-Miranda
- Texas A&M Health Science Center, Dallas, TX, USA; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA; Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | - Parag Kale
- Texas A&M Health Science Center, Dallas, TX, USA; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA; Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | - Shelley A Hall
- Texas A&M Health Science Center, Dallas, TX, USA; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA; Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | - Teena Sam
- Department of Pharmacy, Baylor University Medical Center, Dallas, TX, USA.
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