Late Calcineurin Inhibitor Withdrawal Prevents Progressive Left Ventricular Diastolic Dysfunction in Renal Transplant Recipients

Mourer, Jacqueline S., Ewe, See Hooi, Mallat, Marko J. K., Ng, Arnold C. T., Rabelink, Ton J., Bax, Jeroen J., Delgado, Victoria and de Fijter, Johan W. (2012) Late Calcineurin Inhibitor Withdrawal Prevents Progressive Left Ventricular Diastolic Dysfunction in Renal Transplant Recipients. Transplantation, 94 7: 721-728. doi:10.1097/TP.0b013e3182603297

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Author Mourer, Jacqueline S.
Ewe, See Hooi
Mallat, Marko J. K.
Ng, Arnold C. T.
Rabelink, Ton J.
Bax, Jeroen J.
Delgado, Victoria
de Fijter, Johan W.
Title Late Calcineurin Inhibitor Withdrawal Prevents Progressive Left Ventricular Diastolic Dysfunction in Renal Transplant Recipients
Journal name Transplantation   Check publisher's open access policy
ISSN 0041-1337
1534-6080
Publication date 2012-10
Year available 2012
Sub-type Article (original research)
DOI 10.1097/TP.0b013e3182603297
Volume 94
Issue 7
Start page 721
End page 728
Total pages 8
Place of publication Philadelphia, PA United States
Publisher Lippincott Williams and Wilkins
Collection year 2013
Language eng
Formatted abstract
Background: Calcineurin inhibitor (CNI)-based therapy is associated with adverse cardiovascular effects. We examined the effects of late CNI or mycophenolate mofetil (MMF) withdrawal on echocardiographic parameters.

Methods: This study was conducted as a substudy of a randomized trial in stable renal transplant recipients who were on a triple CNI-based regimen with prednisone and MMF that evaluated late concentration-controlled withdrawal of CNI or MMF on renal function. A total of 108 patients (age, 52.3±11.5 years; 67% male; at a median of 2.0 years post-transplantation, (interquartile range 1.3-3.3 years); estimated glomerular filtration rate, 57±16 mL/min/1.73 m; 66% on cyclosporine and 34% on tacrolimus) entered the cardiovascular substudy examining echocardiographic parameters at baseline and 2 years after randomization. In all patients, traditional cardiovascular risk factors were treated according to predefined targets.

Results: Late CNI withdrawal prevented progressive development of left ventricular (LV) diastolic dysfunction, as assessed by markers of LV diastolic function (mitral deceleration time and mitral annular e′ velocity). Conversely, in the MMF-withdrawal group, the left atrial volume index (an indicator of chronic LV diastolic dysfunction) was significantly increased at 2 years (from 24.1±6.7 to 27.0±7.0 mL/m, P<0.05). In addition, CNI withdrawal resulted in a higher proportion of patients achieving the predefined blood pressure targets (<130/85 mm Hg: 41.5% vs. 12.7%, P=0.001) at 2 years while requiring less antihypertensive drugs. Changes in the left atrial volume index were significantly associated with treatment arm (P=0.03) and changes in systolic (P=0.005) and diastolic (P=0.005) blood pressure.

Conclusions: Late CNI withdrawal, from a triple-drug regimen in stable renal transplant recipients, prevented progressive deterioration of LV diastolic function and facilitated better blood pressure control
Keyword Kidney transplantation
Calcineurin inhibitor
Mycophenolate mofetil
Cardiovascular disease
Containing Immunosuppressive Regimen
Left Atrial Volume
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
 
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Created: Sun, 14 Apr 2013, 23:33:04 EST by Dr Chin Tse Arnold Ng on behalf of Medicine - Princess Alexandra Hospital