Cardiovascular risk profile in nondiabetic renal transplant patients: cyclosporine versus tacrolimus

Hernández, Domingo; Alvarez, Alejandra; Torres, Armando; F, Oppenheimer; Cobo, Marian; González-Posada, José Manuel; Jiménez, Alejandro; Lorenzo, V.; Torregrosa, Vicens

doi:10.1016/s0041-1345(03)00630-4

Cited by 18 publications

(13 citation statements)

References 10 publications

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“…pre‐transplant coronary artery disease, post‐transplant lipidemia, hypertension) were unavailable and thus were not able to be assessed or controlled for in the analysis. Long‐term cyclosporine use is also associated with increased post‐transplant CV disease and risk factors (18–19). We did not examine long‐term use of CNIs and are unable to determine if longer duration cyclosporine treatment contributed to differences in outcomes.…”

Section: Discussionmentioning

confidence: 99%

Mycophenolate mofetil vs. azathioprine is associated with decreased acute rejection, late acute rejection, and risk for cardiovascular death in renal transplant recipients with pre‐transplant diabetes

David¹,

Morris²,

Steffen³

et al. 2005

Clinical Transplantation

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Outcomes specifically in mycophenolate mofetil (MMF)-treated diabetic renal transplant patients have not been previously reported. This study compared acute rejection (AR), late acute rejection (LAR), patient survival [and specifically death from cardiovascular (CV), infectious and malignant causes], incidence of post-transplant malignancies, and graft loss in MMF- or azathioprine (AZA)-treated renal transplant patients with pre-transplant diabetes. Outcomes were compared between MMF- (n = 14 144) and AZA- (n = 3001) treated diabetic patients using the Scientific Registry of Transplant Recipients data on all U.S. adult renal transplants performed between 1995 and 2002. Statistical analyses included Kaplan-Meier survival analysis, Cox multivariable regression and chi-square tests. MMF patients had less AR compared with AZA-treated patients (23.5% vs. 28.3%, p < 0.001) and less risk for LAR over 4 yr [hazard ratio (HR): 0.64, 95% CI 0.44, 0.92; p = 0.02]. While time to any-cause death did not differ between the groups, MMF treatment was associated with a 20% decreased risk of CV death (HR: 0.80, 95% CI 0.67, 0.97; p = 0.020) compared with AZA treatment. MMF patients also had a lower incidence of malignancies than AZA patients (2.2% vs. 3.7%, p < 0.001). These results suggest treatment with MMF compared with treatment with AZA in diabetic transplant patients is associated with less AR, less risk of LAR, a decreased risk of CV death, and a lower incidence of malignancies.

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Section: Discussionmentioning

confidence: 99%

Mycophenolate mofetil vs. azathioprine is associated with decreased acute rejection, late acute rejection, and risk for cardiovascular death in renal transplant recipients with pre‐transplant diabetes

David¹,

Morris²,

Steffen³

et al. 2005

Clinical Transplantation

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“…The average weight gain in the first transplant year posttransplantation range from 22-30 pounds with a threefold increase in the fraction of recipients who attained BMI Ͼ30 (from 10% pretransplant to 30%) (143). Comprehensive weight reduction program should be undertaken when excessive weight gain is observed in the posttransplant period as data shows an independent increased risk of both glucose intolerance and cardiovascular disease in recipients with high BMI (124,144). High pulse pressure is an independent risk factor for CVD morbidity and mortality (145).…”

Section: Other Risk Factorsmentioning

confidence: 99%

Cardiovascular Complications After Renal Transplantation and Their Prevention

Ojo¹

2006

Transplantation

392

226

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By the time of renal transplantation, end-stage renal disease patients have a huge burden of cardiovascular disease (CVD) and are heavily saturated with atherosclerotic risk factors. Worsening of preexisting risk factors or new CVD risk factors may develop in the posttransplant period consequent in part to the diabetogenic and atherogenic potential of immunosuppressive drugs. The annual risk of a fatal or non-fatal CVD event of 3.5 to 5% in kidney transplant recipients is 50-fold higher than the general population. Renal allograft dysfunction, proteinuria, anemia, moderate hyperhomocysteinemia and elevated serum C-reactive protein concentrations, each dependently confer greater risk of CVD morbidity and mortality in the posttransplant period. Long-term care of renal transplant recipients should programmatically incorporate the recommendations of the National Kidney Foundation Working Groups and European Best Practice Guidelines Expert Group on Renal Transplantations into the management of hypertension, dyslipidemia, smoking, and posttransplant diabetes mellitus. Timely utilization of coronary revascularization procedures should be undertaken as these treatments are equally effective in the kidney transplant population.

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“…Among these, primary immunosuppression with a tacrolimusbased regimen is associated with better cardiovascular risk profile than a CyA-based regimen in nondiabetic patients [28] (although there is no evidence that this improvement translates to reduced cardiovascular events) and results in fewer and less severe acute rejection episodes [29]. These advantages are reviewed in detail elsewhere [30] but have prompted investigation into substitution of tacrolimus for CyA.…”

Section: Cyclosporine and Tacrolimus: Which Cni Is Better For Can?mentioning

confidence: 99%

What we CAN do about chronic allograft nephropathy: Role of immunosuppressive modulations

Afzali

Taylor

Goldsmith

2005

Kidney International

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Given the potency of modern immunosuppressive agents, kidney transplantation across alloantingen barriers is a routine phenomenon with excellent 1-year graft survival in most centers. However, the improvement in 1-year graft survival has not been matched by improvements in long-term graft function and chronic allograft nephropathy (CAN) remains the second commonest cause of graft attrition over time. Calcineurin inhibitors, namely cyclosporine A (CyA) and tacrolimus, have been implicated as causal agents in the development of the fibrotic processes that are the hallmarks of CAN. Many studies have, therefore, concentrated on the improvement of long term graft function through the modulation of immunosuppressive therapy. It is the purpose of this review to describe and appraise the available evidence for the prevention and management of CAN through modulation of immunosuppressive agents.

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Cardiovascular risk profile in nondiabetic renal transplant patients: cyclosporine versus tacrolimus

Cited by 18 publications

References 10 publications

Mycophenolate mofetil vs. azathioprine is associated with decreased acute rejection, late acute rejection, and risk for cardiovascular death in renal transplant recipients with pre‐transplant diabetes

Mycophenolate mofetil vs. azathioprine is associated with decreased acute rejection, late acute rejection, and risk for cardiovascular death in renal transplant recipients with pre‐transplant diabetes

Cardiovascular Complications After Renal Transplantation and Their Prevention

What we CAN do about chronic allograft nephropathy: Role of immunosuppressive modulations

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