{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T20:49:14Z","timestamp":1762375754250},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,9,12]],"date-time":"2013-09-12T00:00:00Z","timestamp":1378944000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We sought to determine the incidence, risk factors, and consequences of acute rejection (<jats:styled-content style=\"fixed-case\">AR<\/jats:styled-content>) after conversion from a calcineurin inhibitor (<jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>) to a proliferation signal inhibitor (<jats:styled-content style=\"fixed-case\">PSI<\/jats:styled-content>) in maintenance heart transplantation. Relevant clinical data were retrospectively obtained for 284 long\u2010term heart transplant recipients from nine centers in whom <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>s were replaced with a <jats:styled-content style=\"fixed-case\">PSI<\/jats:styled-content> (sirolimus or everolimus) between <jats:styled-content style=\"fixed-case\">O<\/jats:styled-content>ctober 2001 and <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>arch 2009. The rejection rate at one\u00a0yr was 8.3%, stabilizing to 2% per year thereafter. The incidence rate after conversion (4.9 per 100 patient\u2010years) was significantly higher than that observed on <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content> therapy in the pre\u2010conversion period (2.2 per 100 patient\u2010years). By multivariate analysis, rejection risk was associated with a history of late <jats:styled-content style=\"fixed-case\">AR<\/jats:styled-content> prior to <jats:styled-content style=\"fixed-case\">PSI<\/jats:styled-content> conversion, early conversion (&lt;5\u00a0yr) after transplantation and age &lt;50\u00a0yr at the time of conversion. Use of mycophenolate mofetil was a protective factor. Post\u2010conversion rejection did not significantly influence the evolution of left ventricular ejection fraction, renal function, or mortality during further follow\u2010up. Conversion to a <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>\u2010free immunosuppression based on a <jats:styled-content style=\"fixed-case\">PSI<\/jats:styled-content> results in an increased risk of <jats:styled-content style=\"fixed-case\">AR<\/jats:styled-content>. Awareness of the clinical determinants of post\u2010conversion rejection could help to refine the current <jats:styled-content style=\"fixed-case\">PSI<\/jats:styled-content> conversion strategies.<\/jats:p>","DOI":"10.1111\/ctr.12241","type":"journal-article","created":{"date-parts":[[2013,9,12]],"date-time":"2013-09-12T10:03:29Z","timestamp":1378980209000},"source":"Crossref","is-referenced-by-count":7,"title":["Rejection after conversion to a proliferation signal inhibitor in chronic heart transplantation"],"prefix":"10.1111","volume":"27","author":[{"given":"Francisco","family":"Gonz\u00e1lez\u2010V\u00edlchez","sequence":"first","affiliation":[{"name":"Heart Failure and Cardiac Transplantation Unit Cardiology Service Instituto de Formaci\u00f3n e Investigaci\u00f3n Marqu\u00e9s de Valdecilla (IFIMAV) University Hospital Marques de Valdecilla Santander Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 A.","family":"V\u00e1zquez de Prada","sequence":"additional","affiliation":[{"name":"Heart Failure and Cardiac Transplantation Unit Cardiology Service Instituto de Formaci\u00f3n e Investigaci\u00f3n Marqu\u00e9s de Valdecilla (IFIMAV) University Hospital Marques de Valdecilla Santander Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda J.","family":"Paniagua","sequence":"additional","affiliation":[{"name":"Heart Failure and Cardiac Transplantation Unit Cardiology Service University Hospital de La Coru\u00f1a La Coru\u00f1a Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Almenar","sequence":"additional","affiliation":[{"name":"Heart Failure and Cardiac Transplantation Unit Cardiology Service University Hospital La Fe Valencia Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia","family":"Mirabet","sequence":"additional","affiliation":[{"name":"Heart Failure and Cardiac Transplantation Unit Cardiology Service University Hospital Santa Creu i Sant Pau Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"G\u00f3mez\u2010Bueno","sequence":"additional","affiliation":[{"name":"Heart Failure and Cardiac Transplantation Unit Cardiology Service University Hospital Puerta de Hierro Majadahonda Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"D\u00edaz\u2010Molina","sequence":"additional","affiliation":[{"name":"Heart Failure and Cardiac Transplantation Unit Cardiology Service University Hospital Central de Asturias Oviedo Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose M.","family":"Ariz\u00f3n","sequence":"additional","affiliation":[{"name":"Heart Failure and Cardiac Transplantation Unit Cardiology Service University Hospital Reina Sofia Cordoba 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