BACKGROUND:Cardiovascular mortality is extraordinarily high in renal allograft recipients and accounts for almost half of all allograft losses. Whereas the immunosuppression with calcineurin inhibitors is associated with an increased cardiovascular risk, beneficial effects of mammalian target of rapamycin inhibitors on the vascular system are suspected. METHODS: In a randomized clinical trial, we evaluated the impact on pulse wave velocity (PWV) of a switch from cyclosporine A (CsA) to everolimus (EVR), 6 months after transplantation, in 27 stable de-novo renal allograft recipients. PWV was assessed before and after randomization to the different immunosuppressive protocols at 6 and 15 months post-transplantation, respectively. Seventeen out of 27 patients included in the analysis were switched to EVR; 10 out of 27 were kept on CsA. RESULTS: The switch of immunosuppressive therapy from CsA to EVR resulted in stable PWV (9.50+/-1.92 vs. 9.13+/-1.62 m/s, DeltaPWV= -0.37+/-1.14 m/s, P=0.16), whereas a significant increase of PWV (9.93+/-1.94 vs. 10.8+/-2.24 m/s, DeltaPWV=0.89+/-1.47 m/s, P=0.03) was observed in patients on continued CsA therapy. CONCLUSION: In renal allograft recipients, the prolonged treatment with CsA was associated with a significant increase of PWV whereas no further deterioration of large vessel compliance was observed in patients that were switched to EVR 6 months post transplantation. The cardiovascular risk profile in stable de-novo renal allograft recipients might therefore be positively impacted by an early switch of the primary immunosuppressive therapy from CsA to EVR.
RCT Entities:
BACKGROUND: Cardiovascular mortality is extraordinarily high in renal allograft recipients and accounts for almost half of all allograft losses. Whereas the immunosuppression with calcineurin inhibitors is associated with an increased cardiovascular risk, beneficial effects of mammalian target of rapamycin inhibitors on the vascular system are suspected. METHODS: In a randomized clinical trial, we evaluated the impact on pulse wave velocity (PWV) of a switch from cyclosporine A (CsA) to everolimus (EVR), 6 months after transplantation, in 27 stable de-novo renal allograft recipients. PWV was assessed before and after randomization to the different immunosuppressive protocols at 6 and 15 months post-transplantation, respectively. Seventeen out of 27 patients included in the analysis were switched to EVR; 10 out of 27 were kept on CsA. RESULTS: The switch of immunosuppressive therapy from CsA to EVR resulted in stable PWV (9.50+/-1.92 vs. 9.13+/-1.62 m/s, DeltaPWV= -0.37+/-1.14 m/s, P=0.16), whereas a significant increase of PWV (9.93+/-1.94 vs. 10.8+/-2.24 m/s, DeltaPWV=0.89+/-1.47 m/s, P=0.03) was observed in patients on continued CsA therapy. CONCLUSION: In renal allograft recipients, the prolonged treatment with CsA was associated with a significant increase of PWV whereas no further deterioration of large vessel compliance was observed in patients that were switched to EVR 6 months post transplantation. The cardiovascular risk profile in stable de-novo renal allograft recipients might therefore be positively impacted by an early switch of the primary immunosuppressive therapy from CsA to EVR.
Authors: Luca Zanoli; Paolo Lentini; Marie Briet; Pietro Castellino; Andrew A House; Gerard M London; Lorenzo Malatino; Peter A McCullough; Dimitri P Mikhailidis; Pierre Boutouyrie Journal: J Am Soc Nephrol Date: 2019-04-30 Impact factor: 10.121
Authors: Rizky Indrameikha Sugianto; Karen Ostendorf; Nima Memaran; Anette Melk; Elena Bauer; Jeannine von der Born; Jun Oh; Markus J Kemper; Rainer Buescher; Bernhard M W Schmidt Journal: Pediatr Nephrol Date: 2022-09-12 Impact factor: 3.651
Authors: Manhal Izzy; Brett E Fortune; Marina Serper; Nicole Bhave; Andrew deLemos; Juan F Gallegos-Orozco; Cesar Guerrero-Miranda; Shelley Hall; Matthew E Harinstein; Maria G Karas; Michael Kriss; Nicholas Lim; Maryse Palardy; Deirdre Sawinski; Emily Schonfeld; Anil Seetharam; Pratima Sharma; Jose Tallaj; Darshana M Dadhania; Lisa B VanWagner Journal: Am J Transplant Date: 2022-03-31 Impact factor: 9.369