Cardiac allograft vasculopathy (CAV) is a major cause of mortality and morbidity after heart transplantation. Proliferation signal inhibitors (PSIs) have been demonstrated to slow the progression of CAV in de novo heart transplant recipients, but limited evidence is available regarding their efficacy in patients with established CAV. This manuscript describes the case of a patient in whom everolimus was introduced eight years after transplant, replacing azathioprine. The patient was known to have CAV since the fourth post-transplant year, and had suffered an anterior myocardial infarction 7.5 years after transplant. This was treated with primary percutaneous transluminal coronary angioplasty plus stenting of an occluded mid left anterior descending artery. After a few weeks on everolimus, the patient developed pneumonia, followed by acute, reversible renal failure and reversible leukopenia. This was due to improper management of immunosuppressive agents and concomitant medications, despite recommendations regarding drug- drug interactions. The patient recovered and subsequently remained stable, with mild reduced left ventricular ejection fraction (48-45%), and New York Heart Association functional class I-II up to three years. Control coronary angiography one year after starting everolimus was unchanged, showing good patency of the stent and stable diffuse CAV. An increasing number of long-term heart transplant recipients are at risk of clinical manifestations of CAV, and PSIs appear to have promise in reducing this risk. Favorable data from small studies and case reports are currently being investigated in large clinical trials.
Case Report: long-term outcome of a heart transplant recipient switched to everolimus after an acute myocardial infarction
2006
Abstract
Cardiac allograft vasculopathy (CAV) is a major cause of mortality and morbidity after heart transplantation. Proliferation signal inhibitors (PSIs) have been demonstrated to slow the progression of CAV in de novo heart transplant recipients, but limited evidence is available regarding their efficacy in patients with established CAV. This manuscript describes the case of a patient in whom everolimus was introduced eight years after transplant, replacing azathioprine. The patient was known to have CAV since the fourth post-transplant year, and had suffered an anterior myocardial infarction 7.5 years after transplant. This was treated with primary percutaneous transluminal coronary angioplasty plus stenting of an occluded mid left anterior descending artery. After a few weeks on everolimus, the patient developed pneumonia, followed by acute, reversible renal failure and reversible leukopenia. This was due to improper management of immunosuppressive agents and concomitant medications, despite recommendations regarding drug- drug interactions. The patient recovered and subsequently remained stable, with mild reduced left ventricular ejection fraction (48-45%), and New York Heart Association functional class I-II up to three years. Control coronary angiography one year after starting everolimus was unchanged, showing good patency of the stent and stable diffuse CAV. An increasing number of long-term heart transplant recipients are at risk of clinical manifestations of CAV, and PSIs appear to have promise in reducing this risk. Favorable data from small studies and case reports are currently being investigated in large clinical trials.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
