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665 Combined Heart-Kidney Transplant Compared to Heart Transplant Alone May Reduce Long Term Development of Cardiac Allograft Vasculopathy
Abstracts
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similar for all groups (p⫽0.2). Post-transplant eGFR was significantly different between groups at 3 months and up to year 4 (p⬍0.05; Figure 1). At year 1, 2004-08 recipients had a significantly higher eGFR compared to each other group (p⬍0.05 for all). These patients received hearts from older donors (p⬍0.05) and were less likely to have pre-transplant ischemic heart failure (p⬍0.01) than those transplanted between 1983 and 2003. One year post-transplant, they also exhibited lower blood pressure, LDL and total cholesterol, tacrolimus doses and levels, and prednisone use compared to all other recipients, as well as more frequent tacrolimus and MMF use (p⬍0.05 for all).
Conclusions: Post-heart transplant renal function has improved in patients transplanted between 2004 and 2008 at our institution. Preliminary results suggest that factors related to post-transplant management might explain this finding. Ongoing analyses will evaluate the independent association of these factors with renal function. Funded by Hoffmann-La Roche. 665 Combined Heart-Kidney Transplant Compared to Heart Transplant Alone May Reduce Long Term Development of Cardiac Allograft Vasculopathy L. Czer, J. Patel, M. Kittleson, M. Rafiei, L. Stern, D. Chang, A. Trento, J. Kobashigawa. Cedars-Sinai Heart Institute, Los Angeles, CA. Purpose: Combined heart-kidney transplantation has been reported to reduce first year rejection incidence compared to heart transplant alone. It is not known whether heart-kidney transplant protects these patients (pts) from the development of cardiac allograft vasculopathy (CAV) compared to heart transplant alone. We sought to test these observations by reviewing our pts on a similar post-operative care regimen over 10 years as to whether combined heart-kidney transplant can reduce first year rejection or development of CAV compared to heart transplant alone. Methods and Materials: Between 1994 and 2011, we reviewed 1,435 heart transplant pts and identified 34 pts who underwent combined heartkidney transplant. Heart transplant alone occurred in the rest of these pts (N⫽1,401). All pts were observed for 10 year freedom from the development of CAV defined as any angiographic stenosis greater than 30% and freedom from non-fatal major adverse cardiac events (NF-MACE defined as MI, CHF, need for PCI or pacemaker/ICU, stroke). Freedom from 1st year rejection was also assessed. Results: Freedom from 1st year rejection was similar in both the combined heart-kidney group and heart transplant alone group (table). Freedom from CAV at 10 years revealed a trend for less development of CAV in the combined heart-kidney compared to the heart transplant alone group. Both groups had similar freedom from NF-MACE.
Outcomes 10-Year Actuarial Survival 10-Year Freedom from CAV 10-Year Freedom from NF-MACE 1-Year Freedom from Any-Treated Rejection
Combined Heart Tx Heart-Kidney (N ⫽ 1,187) Tx (N ⫽ 27) P-Value 70% 70% 81%
74% 85% 85%
0.62 0.09 0.61
83%
93%
0.18
Conclusions: Combined heart-kidney transplant compared to heart transplant alone does not appear to protect against first-year rejection nor the development of NF-MACE at 10 years. There is a suggestion that at 10 years, there may be a protective effect against the development of CAV. A larger number of patients is needed to confirm these findings. 666 Prostate Cancer after Heart Transplantation: Incidence and Prognosis. Data from the Spanish Post-Heart-Transplant Tumour Registry B. Díaz-Molina,1 V. Brossa,2 G. Rábago,3 L. Alonso-Pulpón,4 F. Vilchez,5 J. Palomo,6 N. Manito,7 L. Almenar,8 J. Delgado,9 J.M. Arizón,10 E. Lage,11 J.L. Lambert,1 F. Pérez-Villa,12 T. Blasco,13 D. Pascual,14 L. Fuente,15 M. Crespo-Leiro.16 1Hospital Universitario Central de Asturias, Oviedo, Spain; 2Hospital Santa Creu i Sant Pau, Barcelona, Spain; 3Clínica Universitaria de Navarra, Pamplona, Spain; 4 Hospital Puerta de Hierro, Madrid, Spain; 5Hospital Universitario Marques de Valdecilla, Santander, Spain; 6Hospital General Universitario Gregorio Marañon, Madrid, Spain; 7Hospital Universitario de Bellvitge, Barcelona, Spain; 8Hospital Universitario La Fe, Valencia, Spain; 9Hospital Universitario 12 de Octubre, Madrid, Spain; 10Hospital Reina Sofia, Córdoba, Spain; 11Hospital Virgen del Rocío, Sevilla, Spain; 12Hospital Clínic i Provincial, Barcelona, Spain; 13 Hospital Universitario Miguel Servet, Zaragoza, Spain; 14Hospital Universitario Virgen de la Arrixaca, Murcia, Spain; 15Hospital Clínico de Valladolid, Valladolid, Spain; 16Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain. Purpose: Prostate cancer is the most frequent cancer among males in Spain, with an estimated incidence in the general population of 57,2 cases per 100,000 persons at risk (Globocan estimates). Aim: To determine the incidence, characteristics and survival of post-HT prostate cancer in a large series of patients. Methods and Materials: The Spanish Post-Heart-Transplant Tumour Registry maintains, for all patients who have undergone HT in Spain since 1984, records on post-HT tumours. This study concerned patients aged ⱖ15 years who survived ⬎3 months and developed prostate CA after HT between 1984 and 31/12/2010. Variables recorded: age at HT, time after HT at which prostate CA was diagnosed, pathologic group, whether the tumour was localized or disseminated at diagnosis; whether curative, palliative or no surgery was performed, and post-diagnosis survival time up to 31/12/2010. Results: Among 3874 male HT patients satisfying the other conditions for inclusion in the study, 74 (0.2%) developed prostate CA. In three of these patients, the cancer was diagnosed on autopsy. By age group, 4 (5.4%) were ⬍45 years at HT, 16 (21.6%) 45-54 years, 39 (52.7%) 55-64 years and 15 (20.3%) older than 65 years. Mean time between HT and prostate cancer was 7.9 years (SD 5.5 years), incidence of 2.4 per 1,000 person-years (95% CI 1.9-3.0). Curative surgery was performed in 19 cases (28.4%) and no surgery in 46 (68.7%). 27 patients of 71 died during follow up. Conclusions: As previously reported for lung cancer, incidence of prostate cancer among HT Spanish patients is much higher than in the general Spanish population. 667 Development of Serum Lipids in Everolimus Treated Heart Recipients H. Lehmkuhl, C. Bara, A. Zuckermann, P. Lopez, G. Dong, S. Hirt. A2310 Study Group, Basel, Switzerland. Purpose: The 12-month results of study 2310 IVUS sub-study in de novo HTx patients (pts) showed that the antiproliferative effect of everolimus (EVR) on the arterial intima was maintained, irrespective of higher lipid values with EVR compared to mycophenolate mofetil (MMF). The 24 month analysis of 2310 assessed the further development of lipid profiles. Methods and Materials: 721 HTxR were randomized to 1.5mg (N⫽282) or 3mg/day (N⫽168) EVR (target C0: 3-8 or 6-12ng/mL) with reduced dose cyclosporine (rdCsA) or 3g/day MMF with standard dose CsA (sdCsA) (N⫽271) ⫹ steroids ⫹/⫺ induction. The EVR 3mg arm was prematurely terminated due to higher mortality. The final 24M lipid anal-
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similar for all groups (p⫽0.2). Post-transplant eGFR was significantly different between groups at 3 months and up to year 4 (p⬍0.05; Figure 1). At year 1, 2004-08 recipients had a significantly higher eGFR compared to each other group (p⬍0.05 for all). These patients received hearts from older donors (p⬍0.05) and were less likely to have pre-transplant ischemic heart failure (p⬍0.01) than those transplanted between 1983 and 2003. One year post-transplant, they also exhibited lower blood pressure, LDL and total cholesterol, tacrolimus doses and levels, and prednisone use compared to all other recipients, as well as more frequent tacrolimus and MMF use (p⬍0.05 for all).
Conclusions: Post-heart transplant renal function has improved in patients transplanted between 2004 and 2008 at our institution. Preliminary results suggest that factors related to post-transplant management might explain this finding. Ongoing analyses will evaluate the independent association of these factors with renal function. Funded by Hoffmann-La Roche. 665 Combined Heart-Kidney Transplant Compared to Heart Transplant Alone May Reduce Long Term Development of Cardiac Allograft Vasculopathy L. Czer, J. Patel, M. Kittleson, M. Rafiei, L. Stern, D. Chang, A. Trento, J. Kobashigawa. Cedars-Sinai Heart Institute, Los Angeles, CA. Purpose: Combined heart-kidney transplantation has been reported to reduce first year rejection incidence compared to heart transplant alone. It is not known whether heart-kidney transplant protects these patients (pts) from the development of cardiac allograft vasculopathy (CAV) compared to heart transplant alone. We sought to test these observations by reviewing our pts on a similar post-operative care regimen over 10 years as to whether combined heart-kidney transplant can reduce first year rejection or development of CAV compared to heart transplant alone. Methods and Materials: Between 1994 and 2011, we reviewed 1,435 heart transplant pts and identified 34 pts who underwent combined heartkidney transplant. Heart transplant alone occurred in the rest of these pts (N⫽1,401). All pts were observed for 10 year freedom from the development of CAV defined as any angiographic stenosis greater than 30% and freedom from non-fatal major adverse cardiac events (NF-MACE defined as MI, CHF, need for PCI or pacemaker/ICU, stroke). Freedom from 1st year rejection was also assessed. Results: Freedom from 1st year rejection was similar in both the combined heart-kidney group and heart transplant alone group (table). Freedom from CAV at 10 years revealed a trend for less development of CAV in the combined heart-kidney compared to the heart transplant alone group. Both groups had similar freedom from NF-MACE.
Outcomes 10-Year Actuarial Survival 10-Year Freedom from CAV 10-Year Freedom from NF-MACE 1-Year Freedom from Any-Treated Rejection
Combined Heart Tx Heart-Kidney (N ⫽ 1,187) Tx (N ⫽ 27) P-Value 70% 70% 81%
74% 85% 85%
0.62 0.09 0.61
83%
93%
0.18
Conclusions: Combined heart-kidney transplant compared to heart transplant alone does not appear to protect against first-year rejection nor the development of NF-MACE at 10 years. There is a suggestion that at 10 years, there may be a protective effect against the development of CAV. A larger number of patients is needed to confirm these findings. 666 Prostate Cancer after Heart Transplantation: Incidence and Prognosis. Data from the Spanish Post-Heart-Transplant Tumour Registry B. Díaz-Molina,1 V. Brossa,2 G. Rábago,3 L. Alonso-Pulpón,4 F. Vilchez,5 J. Palomo,6 N. Manito,7 L. Almenar,8 J. Delgado,9 J.M. Arizón,10 E. Lage,11 J.L. Lambert,1 F. Pérez-Villa,12 T. Blasco,13 D. Pascual,14 L. Fuente,15 M. Crespo-Leiro.16 1Hospital Universitario Central de Asturias, Oviedo, Spain; 2Hospital Santa Creu i Sant Pau, Barcelona, Spain; 3Clínica Universitaria de Navarra, Pamplona, Spain; 4 Hospital Puerta de Hierro, Madrid, Spain; 5Hospital Universitario Marques de Valdecilla, Santander, Spain; 6Hospital General Universitario Gregorio Marañon, Madrid, Spain; 7Hospital Universitario de Bellvitge, Barcelona, Spain; 8Hospital Universitario La Fe, Valencia, Spain; 9Hospital Universitario 12 de Octubre, Madrid, Spain; 10Hospital Reina Sofia, Córdoba, Spain; 11Hospital Virgen del Rocío, Sevilla, Spain; 12Hospital Clínic i Provincial, Barcelona, Spain; 13 Hospital Universitario Miguel Servet, Zaragoza, Spain; 14Hospital Universitario Virgen de la Arrixaca, Murcia, Spain; 15Hospital Clínico de Valladolid, Valladolid, Spain; 16Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain. Purpose: Prostate cancer is the most frequent cancer among males in Spain, with an estimated incidence in the general population of 57,2 cases per 100,000 persons at risk (Globocan estimates). Aim: To determine the incidence, characteristics and survival of post-HT prostate cancer in a large series of patients. Methods and Materials: The Spanish Post-Heart-Transplant Tumour Registry maintains, for all patients who have undergone HT in Spain since 1984, records on post-HT tumours. This study concerned patients aged ⱖ15 years who survived ⬎3 months and developed prostate CA after HT between 1984 and 31/12/2010. Variables recorded: age at HT, time after HT at which prostate CA was diagnosed, pathologic group, whether the tumour was localized or disseminated at diagnosis; whether curative, palliative or no surgery was performed, and post-diagnosis survival time up to 31/12/2010. Results: Among 3874 male HT patients satisfying the other conditions for inclusion in the study, 74 (0.2%) developed prostate CA. In three of these patients, the cancer was diagnosed on autopsy. By age group, 4 (5.4%) were ⬍45 years at HT, 16 (21.6%) 45-54 years, 39 (52.7%) 55-64 years and 15 (20.3%) older than 65 years. Mean time between HT and prostate cancer was 7.9 years (SD 5.5 years), incidence of 2.4 per 1,000 person-years (95% CI 1.9-3.0). Curative surgery was performed in 19 cases (28.4%) and no surgery in 46 (68.7%). 27 patients of 71 died during follow up. Conclusions: As previously reported for lung cancer, incidence of prostate cancer among HT Spanish patients is much higher than in the general Spanish population. 667 Development of Serum Lipids in Everolimus Treated Heart Recipients H. Lehmkuhl, C. Bara, A. Zuckermann, P. Lopez, G. Dong, S. Hirt. A2310 Study Group, Basel, Switzerland. Purpose: The 12-month results of study 2310 IVUS sub-study in de novo HTx patients (pts) showed that the antiproliferative effect of everolimus (EVR) on the arterial intima was maintained, irrespective of higher lipid values with EVR compared to mycophenolate mofetil (MMF). The 24 month analysis of 2310 assessed the further development of lipid profiles. Methods and Materials: 721 HTxR were randomized to 1.5mg (N⫽282) or 3mg/day (N⫽168) EVR (target C0: 3-8 or 6-12ng/mL) with reduced dose cyclosporine (rdCsA) or 3g/day MMF with standard dose CsA (sdCsA) (N⫽271) ⫹ steroids ⫹/⫺ induction. The EVR 3mg arm was prematurely terminated due to higher mortality. The final 24M lipid anal-