Effect of systemic immunosuppression on coronary in-stent intimal hyperplasia in renal transplant patients

Results:Results are combined for all 13 patients, including the patient not on Sandimmun. The mean Sandimmun whole blood level at the time of coronary intervention was 129 +/- 49 ng/dL. All stents were implanted successfully, and all patients were discharged without complications 48 hours after the procedure. There were no repeat revascularizations, myocardial infarctions, or deaths in the 13 patients. The 3 patients who refused follow-up angiography had a negative stress myocardial perfusion imaging test. 1 insulin-dependent diabetic patient had a silent occlusion of a left anterior descending artery stent, detected at 18-month angiographic follow-up. 9 patients had acute coronary syndrome, including 2 with acute myocardial infarction and 4 with postinfarction angina, and 5 (38%) patients were diabetics. The stented vessels with IVUS follow-up available were the left anterior descending artery (36%), right coronary artery (36%), and left circumflex artery (72%). 12 of the lesions (70%) treated were complex (type B2 or C). There was no in-stent or edge restenosis.; Indications:Graft rejection and coronary in-stent restenosis prophylaxis in 12 patients who underwent kidney transplantation and coronary artery stenting. Coexisting disease was diabetes mellitus (1 insulin-dependent) in 5 patients.; Patients:13 patients, 11 mean and 1 woman, mean age 58 ± 6 years, 12 patients received Sandimmun. Follow-up was >9 months (mean 14 months) after coronary artery stenting.; TypeofStudy:This study evaluated the effect of systemic immunosuppressants, including Sandimmun, on coronary in-stent intimal hyperplasia in renal transplant recipients.; DosageDuration:A mean dose of 171.9 ± 72 mg daily. Duration not stated.; AdverseEffects:No adverse events were mentioned.; AuthorsConclusions:In summary, we found that renal transplant patients who develop coronary artery disease and are treated with stenting have minimal late in-stent intimal proliferation. This finding may be related to the combined immunosuppressive therapy given to avoid kidney rejection, which has known vascular antiproliferative properties.; FreeText:13 renal allograft transplant patients underwent stent implantation to treat 17 coronary artery stenoses (15 arteries). The median time lapse between kidney transplant and coronary artery stenting was 33 months. All patients received aspirin (325 mg daily, indefinitely) and ticlopidine (500 mg daily, for 30 days) starting ≥3 days before the procedure. 10 patients (12 vessels) underwent coronary angiography; and 9 (11 arteries) had intravascular ultrasound (IVUS) imaging performed. The mean angiographic and IVUS follow-up was 14 ± 8 months and all patients completed ≥9 months of clinical follow-up. 3 asymptomatic patients refused to participate in the angiographic follow-up. Sandimmun was combined with prednisone and azathioprine in 11 patients. 1 patient received Sandimmun, prednisone, and micofenolato mophetil, and 1 patient was on azathioprine and prednisone only. Quantitative coronary angiography was performed. Minimal lumen diameter, reference diameter, and percent diameter stenosis were measured before, after stenting, and at follow-up. Continuous imaging of the coronary artery was also performed.