This was a study to compare less intense immunosuppression with a more traditional approach. The hypothesis was that less immunosuppression will provide similar protection against rejection than typical 2-3 drug therapy.
This was a prospective, randomized, controlled (open-label) trial of 2 different strategies of immunosuppression in de novo post-heart transplant patients. The hypothesis was that immunosuppression with tacrolimus and mycophenolate mofetil, coupled with rapid steroid weaning would provide similar anti-rejection efficacy as tacrolimus with only a 2 week course of mycophenolate mofetil but including the same rapid steroid wean. The primary endpoint was the mean International Society for Heart and Lung Transplantation (ISHLT) biopsy score over the first 6 months post-transplant. Secondary endpoints included the incidence of adverse events over the first year post-transplant, as well as all-cause mortality, 12 month ISHLT biopsy score (mean), along with the incidence of proven cytomegalovirus disease. In addition, the incidence of allograft vasculopathy as assessed by angiography or intravascular ultrasound was compared between groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
150
tacrolimus
MMF
Newark Beth Israel Medical Center
Newark, New Jersey, United States
Mt. Sinai Cardiovascular Institute
New York, New York, United States
Mean International Society for Heart and Lung Transplantation Biopsy Score Over the First 6 Months Post-transplantation
Mean ISHLT biopsy score Biopsies of the heart may be various grades and each is assigned a numerical score. Grade 0 is 0 points, 1A = 1, 1B = 2, grade 2 = 3, grade 3A = 4, Grade 3B = 5, and grade 4 = 6 units. The mean biopsy score is the numeric average of the biopsy scores for the first 6 post-transplant months. Best value is 0, worst score is 6.
Time frame: 6 months
Percent of Patients Alive at One Year Post-transplant
Percent of patients alive at one year post-transplant. In other words, all cause mortality over time
Time frame: 1 year
Number of Patients With Cytomegalovirus (CMV) at One Year Post-transplant
Number of patients developing cytomegalovirus disease by 1 year post-transplant
Time frame: 1 year
Number of Patients With Allograft Vasculopathy (CAD) at One Year Post Transplant
Number of patients diagnosed with allograft vasculopathy / coronary artery disease (CAD) at one year post transplant
Time frame: 1 year
Mean ISHLT Biopsy Score Over First Year Post-transplant
Mean ISHLT biopsy score Biopsies of the heart may be various grades and each is assigned a numerical score. Grade 0 is 0 points, 1A = 1, 1B = 2, grade 2 = 3, grade 3A = 4, Grade 3B = 5, and grade 4 = 6 units. The mean biopsy score is the numeric average of the biopsy scores for the first 6 post-transplant months. Best value is 0, worst score is 6.
Time frame: 1 year
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