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Cyclosporine versus tacrolimus (FK 506) for prevention of cardiac allograft vasculopathy

2000; Elsevier BV; Volume: 85; Issue: 2 Linguagem: Inglês

10.1016/s0002-9149(99)00631-1

1879-1913

Volker Klauss, Andreas König, Christoph Spes, B Meiser, Johannes Rieber, Uwe Siebert, E. Regar, Matthias Pfeiffer, Bruno Reichart, K. Theisen, Harald Mudra,

Mechanical Circulatory Support Devices

The development of cardiac allograft vasculopathy (CAV) influences long-term survival after heart transplantation. Because the etiology of this disease is believed to be multifactorial, including nonimmunologic and immune-mediated mechanisms, primary and secondary prevention of CAV currrently focuses on control of classic risk factors and on improvement in immunosuppressive therapies. Tacrolimus (FK 506) is a new macrolide antibiotic that has shown potent immunosuppressive effects in clinical trials associated with a reduction in the incidence of acute rejection. 1 Pham S.M Kormos R.L Hattler B.G Kawai A Tsamandas A.C Demetris A.J Murali S Fricker F.J Chang H.C Jain A.B Starzl T.E Hardesty R.L Griffith B.P A prospective trial of tacrolimus (FK 506) in clinical heart transplantation intermediate-term results. J Thorac Cardiovasc Surg. 1996; 111: 764-772 Abstract Full Text Full Text PDF PubMed Scopus (131) Google Scholar , 2 Rinaldi M Pellegrini C Martinelli L Goggi C Gavazzi A Campana C Arbustini E Grossi Regazzi M Ippoliti G Vigano M FK506 effectiveness in reducing acute rejection after heart transplantation a prospective randomized study. J Heart Lung Transplant. 1997; 10: 1001-1009 Google Scholar , 3 Meiser B.M Überfuhr Fuchs A Schmidt D Pfeiffer M Paulus D Schulze C Wildhirt S von Scheidt W Angermann C.E Klauss V Martin S Reichenspurner H Kreuzer E Reichart B Single-center randomized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of acute myocardial rejection. J Heart Lung Transplant. 1998; 17: 782-788 PubMed Google Scholar Experimental studies, however, have reported, that FK 506 may accelerate rather than prevent the development of CAV. 4 Shibata T Ogawa N Koyama I Ksaneko N Hokazono K Omoto R Does FK506 accelerate the development of coronary artery disease in the transplanted heart as well as in the native heart?. Transplant Proc. 1993; 25: 1145-1148 PubMed Google Scholar , 5 Arai S Teramoto S Senoo Y The impact of FK 506 on graft coronary disease of rat cardiac allograft—a comparison with cyclosporine. J Heart Lung Transplant. 1992; 11: 757-762 PubMed Google Scholar , 6 Meiser B.M Billingham M.E Morris R.E Effects of cyclosporin, FK 506, and rapamycin on graft-vessel disease. Lancet. 1991; 338: 1297-1298 Abstract PubMed Scopus (93) Google Scholar , 7 Wu G.D Cramer D.V Chapman F.A Cajulis E Wang H.K Starzl T.E Makowka L FK 506 inhibits the development of transplant arteriosclerosis. Transplant Proc. 1991; 23: 3272-3274 PubMed Google Scholar Although histologic examination is the gold standard for assessment of CAV in animal models, intravascular ultrasound (IVUS) is the only method that allows a quantitative analysis of CAV in human studies. Because the role of FK 506 on the development of CAV has not been determined in clinical heart transplantation, the aim of this prospective study was to compare the impact of FK 506 and cyclosporine on CAV by utilizing serial IVUS examinations.