Cyclosporine vs. Tacrolimus: Which Is a Better Match With Everolimus?

Abstract

Background: In heart transplant (HTx) patients (pts), everolimus (EVR) may limit cardiac allograft vasculopathy, cytomegalovirus infection, and malignancy. However, there is increased nephrotoxicity when a calcineurin inhibitor (CNI) is combined with EVR. This has been well established in clinical trials using EVR in combination with cyclosporine (CSA). To compare the effect of EVR in combination with CSA vs tacrolimus (TAC), we reviewed the experience at our center. Methods: We assessed 38 HTx pts who were started on EVR in combination with either TAC or CSA between 2000 and 2012. Serum creatinine (SCr) and CNI trough levels were measured at EVR initiation and 1, 3, 6, and 12 months later. Endpoints were assessed: subsequent 1-year survival, 1-year freedom from dialysis, 1-year freedom from rejection. Results: Both TAC and CSA blood levels were maintained in the usual therapeutic range (5-10ng/ml and 100-200 ng/ml respectively) before and after EVR initiation, but pts on EVR /CSA had significantly higher SCr at follow-up (table). There was no significant difference in subsequent 1-year survival, freedom from dialysis, treated cellular rejection, or treated antibody mediated rejection.Table: No Caption available.Conclusion: When used in combination with EVR, TAC is associated with less nephrotoxicity than CSA with no increase in adverse events. Further study in a large patient sample is needed to confirm these findings. DISCLOSURES:Patel, J.: Grant/Research Support, Alexion Pharmaceuticals. Moriguchi, J.: Grant/Research Support, Grant from Thoratec and Syncardia Inc. Chang, D.: Stockholder, Abbot Pharma. Kobashigawa, J.: Grant/Research Support, Xdx Inc., Novartis Phamaceuticals, Transmedics Inc.