Reduced progression of cardiac allograft vasculopathy with routine use of induction therapy with basiliximab
Ricardo Wang1, Lidia Ana Zytynski Moura1, Sergio Veiga Lopes2
1Santa Casa de Curitiba, Curitiba, PR, BR.
Insights
Basiliximab induction therapy reduced intimal layer growth, a key factor in cardiac allograft vasculopathy (CAV), after heart transplantation (HT). This finding suggests basiliximab may improve long-term outcomes for heart transplant recipients.
Area of Science:
- Cardiology
- Immunosuppression
- Transplantation Immunology
Background:
- Cardiac allograft vasculopathy (CAV) significantly limits long-term survival post-heart transplantation (HT).
- Certain immunosuppressive agents show potential in mitigating CAV risk.
Purpose of the Study:
- To compare intimal layer volumetric growth via intracoronary ultrasound (IVUS) one year after HT.
- To assess the impact of basiliximab induction therapy versus a control group on CAV development.
Main Methods:
- Retrospective analysis of 13 heart transplant patients (2007-2009).
- Intracoronary ultrasound (IVUS) used to measure coronary segment volume at baseline and 1 year post-HT.
- Vasculopathy assessed by intimal volume.
Main Results:
- Basiliximab group showed reduced intimal layer growth (33% increase) compared to the control group (80% increase).
- Control group exhibited greater vessel volume (p=0.051) and significantly higher intimal growth (p=0.015).
- Positive arterial remodeling correlated with increased intimal growth (r=0.85, p<0.001).
Conclusions:
- Routine basiliximab induction therapy is associated with decreased intimal growth in the first year post-HT.
- Basiliximab may be a valuable strategy for reducing CAV progression after heart transplantation.
Introduction:
Cardiac allograft vasculopathy (CAV) is a major limitation for long-term survival of patients undergoing heart transplantation (HT). Some immunosuppressants can reduce the risk of CAV.
Objectives:
The primary objective was to evaluate the variation in the volumetric growth of the intimal layer measured by intracoronary ultrasound (IVUS) after 1 year in patients who received basiliximab compared with that in a control group.
Methods:
Thirteen patients treated at a single center between 2007 and 2009 were analyzed retrospectively. Evaluations were performed with IVUS, measuring the volume of a coronary segment within the first 30 days and 1 year after HT. Vasculopathy was characterized by the volume of the intima of the vessel.
Results:
Thirteen patients included (7 in the basiliximab group and 6 in the control group). On IVUS assessment, the control group was found to have greater vessel volume (120-185.43 mm3 vs. 127.77-131.32 mm3; p = 0.051). Intimal layer growth (i.e., CAV) was also higher in the control group (27.30-49.15 mm3 [∆80%] vs. 20.23-26.69 mm3[∆33%]; p = 0.015). Univariate regression analysis revealed that plaque volume and prior atherosclerosis of the donor were not related to intima growth (r = 0.15, p = 0.96), whereas positive remodeling was directly proportional to the volumetric growth of the intima (r = 0.85, p < 0.001).
Conclusion:
Routine induction therapy with basiliximab was associated with reduced growth of the intima of the vessel during the first year after HT.
