After heart transplant, adding everolimus (EVL) to standard immunosuppressive regimen mostly relies on converting calcineurin inhibitors (CNIs) into EVL. The aim of this study was to describe the effects of combining low‐dose EVL and CNIs in maintenance immunosuppression regimen (quadritherapy) and compare it with standard tritherapy associating standard‐dose CNIs, mycophenolate mofetil, and corticosteroids. In the 3‐year registry cohort of heart transplanted patients, those who received quadritherapy were compared with those who received tritherapy. EVL was added after 3 months posttransplant. Three analyses were performed to control for confounders: propensity score matching, multivariable survival, and inverse probability score weighting analyses. Among 213 patients who were included (75 with quadritherapy), propensity score matching selected 64 unique pairs of patients with similar characteristics. In the matched cohort (n = 128), quadritherapy was associated with fewer deaths (3 [4.7%] vs 17 [21.9%], P = .007) and biopsy‐proven acute rejections (15 [23.4%] vs 31 [48.4%], P = .002). These results were confirmed in the overall cohort (n = 213), after multivariable and inverse probability score weighting analyses. Renal function and donor‐specific HLA‐antibodies remained similar in both groups. Low‐dose combination quadritherapy was associated with fewer deaths and rejections, compared with standard immunosuppression tritherapy.

中文翻译：

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心脏移植后四联疗法与标准三联疗法免疫抑制方案：倾向评分匹配队列分析

心脏移植后，将依维莫司 (EVL) 添加到标准免疫抑制方案中主要依赖于将钙调磷酸酶抑制剂 (CNI) 转化为 EVL。本研究的目的是描述低剂量 EVL 和 CNI 联合维持免疫抑制方案（四联疗法）的效果，并将其与联合标准剂量 CNI、霉酚酸酯和皮质类固醇的标准三联疗法进行比较。在 3 年的心脏移植患者登记队列中，将接受四联疗法的患者与接受三联疗法的患者进行了比较。移植后 3 个月添加 EVL。进行了三种分析来控制混杂因素：倾向得分匹配、多变量生存和逆概率得分加权分析。在纳入的 213 名患者中（75 名接受四联疗法），倾向评分匹配选择了 64 对具有相似特征的独特患者。在匹配队列 (n = 128) 中，四联疗法与较少的死亡相关（3 [4.7%] vs 17 [21.9%]，P  = .007）和活检证实的急性排斥反应（15 [23.4%] 对 31 [48.4%]，P  = .002）。经过多变量和逆概率评分加权分析后，这些结果在整个队列 (n = 213) 中得到证实。肾功能和供体特异性 HLA 抗体在两组中保持相似。与标准免疫抑制三联疗法相比，低剂量联合四联疗法与较少的死亡和排斥反应相关。