466: First-year mycophenolate mofetil dose reductions: Do they portend poor outcome?

particularly for individuals with pre-existing renal disease, has led to the consideration of CNI-free immunosuppression (CNI-F). We report our 7 year experience of three different immunosuppression regimes. Methods and Materials: Of 164 transplants performed, the complete records of 142 recipients were available for review. Early ( 6 months) and late ( 6 months) outcomes were analyzed for three immunosuppression regimes, CNI, CNI-F and CNI mTor inhibitor (CNI mT) according to use at transplant (T0), one month (T1), one year and long-term. At transplant, 88 recipients (62%) received cyclosporine, prednisolone and MMF (88%) or AZA (CNI group); 37 (26%) received sirolimus or everolimus, and MMF, prednisolone (CNI-F group); 17 (12%) received Cyclosporine, sirolimus, prednisolone (CNI mT group). Results: Early Grade 3A rejection was higher in the T0 and T1 CNI–F groups compared to the corresponding CNI groups (incidence for T0, 58% vs 35% p 0.016; T1, 60% vs 34% p 0.003). The incidence of late 3A rejection was not different between the groups. Early bacterial infections were higher in the CNI–F (p 0.037) and CNI mT (p 0.029) groups compared to CNI (incidence 58%; 40%; 32%). Late bacterial infections were higher in the CNI–F compared to the CNI (p 0.01) and CNI mT (p 0.027) groups (incidence 45%; 13%; 11%). Sternal wound infections were higher in the CNI mT compared to CNI (p 0.005) or CNI–F (p 0.015) groups (incidence 31%; 4%; 3%). More pleural effusions occurred in the CNI–F (p 0.004) and CNI mT (p 0.007) groups compared to CNI (incidence 21%; 20%; 3%). The incidence of CMV infection and pericardial effusions was not different between groups. Conclusions: There was increased early rejection, bacterial infections and pleural effusions with early use of CNI free, mTOR based immunosuppression, and lower early rejection in CNI containing regimes. These findings provide important new information, which should influence the selection of immunosuppression for heart transplant recipients. Speaker; Roche, Novartis.