Two-Dose Daclizumab, Tacrolimus, Mycophenolate Mofetil, and Steroid-Free Regimen in De Novo Cardiac Transplant Recipients: Early Experience

Abstract

Background Tacrolimus (TAC) with mycophenolate mofetil (MMF) and a steroid-free regimen seems to have good efficacy in preventing acute rejection in cardiac transplant recipients, although concern exists about nephrotoxicity. Induction therapy with Daclizumab seems to give protection without side effects. Data are lacking about the outcome of 2-dose Daclizumab+TAC+MMF and a steroid-free regimen. Materials and Methods We retrospectively reviewed 28 consecutive de novo heart transplantations performed at a single center between January 2001 and June 2006. Patients received induction therapy with 2-dose Daclizumab. Maintenance immunosuppression included TAC, MMF, and prednisone during the first 6 months. The endpoints were the incidence of acute rejection, patient and graft survival, and clinical tolerability. Results Among 28 patients of mean age 57 ± 9 years, 2 subjects (7%) died in the perioperative period due to infections. The mean follow-up was 2.8 ± 1.5 years. There were no late deaths. Six patients experienced acute rejection (International Society of Heart and Lung Transplantation [ISHLT] ≥3A) that required treatment during the first 3 months. At follow-up, only 3 patients (≥3A) required treatment. Mean creatinine level increased from 1.08 ± 0.37 at baseline to 1.08 ± 0.41 at 1 year (n = 23; P = not significant [NS]) to 1.39 ± 0.68 (n = 13; P < .05) at 4 years, 1.65 ± 0.51 (n = 8; P < .05) at 5 years. No patient required replacement therapy. Conclusions A steroid-free protocol with 2-dose Daclizumab induction therapy and maintenance with TAC and MMF seemed to be safe to prevent acute rejection. Creatinine levels were slightly but significantly increased.