Switch of immunosuppression from cyclosporine A to everolimus: impact on pulse wave velocity in stable de-novo renal allograft recipients

Seckinger, Joerg; Sommerer, Claudia; Hinkel, Ulrich-Paul; Hoffmann, Oskar; Zeier, Martin; Schwenger, Vedat

doi:10.1097/hjh.0b013e32830ef940

Cited by 52 publications

(48 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some of these patients are part of an ongoing prospective study encompassing measurements of vascular function, which has been described in a separate publication (20). Because the scope of our study was that of investigating the reversibility of atherosclerosis (as measured by IMT) after restoration of renal function by renal transplantation and the functional relationship between the longitudinal changes in IMT and CKD-MBD biomarkers, by protocol, we excluded patients with risk factors that may distort the interpretation of carotid artery changes brought about by successful renal transplantation, including diabetes, background cardiovascular disease, smoking, rejection episodes, and use of mammalian target of rapamycin inhibitors, a class of drugs that may per se have a favorable effect on atherosclerosis (21,22). The flowchart of the selection process is shown in Figure 1.…”

Section: Patients and Controlsmentioning

confidence: 99%

“…We selected all patients with uneventful clinical course (no rejection episodes). We excluded five patients on sirolimus or everolimus, because these drugs per se prevent intimal hyperplasia and have a different effect on vascular function compared with standard cyclosporin-based regimens (21,22) and four patients on a regimen including antithymocyte globulin (Muromonab-CD3), a drug that interferes in a complex manner with several components of the inflammation cascade (23). Five additional patients were excluded, because they had acute rejection episodes, and two patients were excluded because of positive cross-match transplant (n=1) or blood group system-incompatible transplant (n=1).…”

Section: Patients and Controlsmentioning

confidence: 99%

See 1 more Smart Citation

A Longitudinal Study of Inflammation, CKD-Mineral Bone Disorder, and Carotid Atherosclerosis after Renal Transplantation

Yılmaz

Sönmez

Sağlam

et al. 2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives The role of reversibility of nontraditional risk factors, like inflammation and CKDmineral bone disorder, in the reduction of cardiovascular risk after renal transplantation is still scarcely defined.Design, setting, participants, and measurements The longitudinal relationship between C-reactive protein, CKDmineral bone disorder biomarkers, and intima media thickness was investigated in a series of 178 patients (age=32610 years) with stage 5 CKD maintained on chronic dialysis who underwent echo-color Doppler studies of the carotid arteries before and after renal transplantation. Smokers and patients with diabetes were excluded from the study. In all patients, immunosuppression was performed by a standard regimen on the basis of calcineurin inhibitors. Healthy controls were specifically selected to match the age and sex distribution of the patients. Biochemical and intima media thickness assessments were repeated 6 months after transplantation.Results Before transplantation, intima media thickness in patients with stage 5 CKD on dialysis (average=0.960.2 mm) was higher (P,0.001) than in well matched healthy controls (0.660.1 mm) and reduced substantially (222%; 95% confidence interval, 224% to 220%) after transplantation (P=0.001). GFR (multivariable-adjusted b=0.23; P,0.001), C-reactive protein (b=0.15; P,0.001), and fibroblast growth factor 23 (b=0.28; P,0.001) were the strongest independent correlates of intima media thickness before transplantation. Similarly, longitudinal changes in the same biomarkers were the sole independent correlates of simultaneous changes in intima media thickness (C-reactive protein: b=0.25; fibroblast growth factor 23: b=0.26; P,0.001 for both) after renal transplantation. The evolution of intima media thickness after transplantation was largely independent of classic risk factors, including BP, LDL cholesterol, and insulin resistance, as measured by homeostatic model assessment.Conclusions Intima media thickness improves after renal transplantation. Such an improvement associates with parallel changes in serum C-reactive protein and fibroblast growth factor 23. These observations are in keeping with the hypothesis that the decline in cardiovascular risk after transplantation, in part, depends on partial resolution of nontraditional cardiovascular risk factors, like inflammation and CKD-mineral bone disorder.

show abstract

Section: Patients and Controlsmentioning

confidence: 99%

Section: Patients and Controlsmentioning

confidence: 99%

A Longitudinal Study of Inflammation, CKD-Mineral Bone Disorder, and Carotid Atherosclerosis after Renal Transplantation

Yılmaz

Sönmez

Sağlam

et al. 2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…Several authors have described a deleterious effect of CNI on arterial stiffness as measured using AI 75 and PWV [19e21,32]. Consistently, PWV decreases after conversion from cyclosporine to an mTOR inhibitor [33]. Interestingly, mTOR inhibitors even have antiarteriosclerotic properties [34].…”

Section: Discussionmentioning

confidence: 81%

Prediction of Cardiovascular Events After Renal Transplantation

Seibert

Behrendt

Pagonas

et al. 2015

Transplantation Proceedings

View full text Add to dashboard Cite

“…Adicionalmente, la enfermedad cardiovascular y las neoplasias son puntos críticos importantes durante el seguimiento del trasplante; los inhibidores mTOR pueden ser una estrategia importante a considerar en receptores de trasplante renal 22,23 , ya que a través de su mecanismo de acción pueden llegar a retardar las lesiones arterioscleróticas progresivas y evitar el impacto negativo en la compliance de grandes vasos, asociado con CsA [24][25][26][27] ; encontrándose, igualmente, asociados con una reducida incidencia de neoplasias 28,29 .…”

Section: Introductionunclassified

24 month follow up to a late conversion from a calcineurin inhibitor regimen to everolimus in kidney transplant recipients

Montero¹,

Aldana²,

Torres³

2015

Rev. Colomb. Nefrol.

View full text Add to dashboard Cite

Rev. Colomb. Nefrol. 2015; 2(2): 78 -95 Conversión tardía desde un régimen basado en inhibidores de calcineurina a everolimus en receptores de trasplante renal. Seguimiento a 24 meses 78Conversión tardía desde un régimen basado en inhibidores de calcineurina a everolimus en receptores de trasplante renal.Seguimiento a 24 meses.Camilo Montero 1 *, Guillermo Aldana 2 , Rodolfo Torres 3Resumen Introducción: La sobrevida del injerto renal a largo plazo ha permanecido estable, sin un aumento significativo en los últimos años. Dentro de las causas principales de pérdida de los injertos renales, en el largo plazo, se encuentran la muerte con injerto renal funcional por causas cardiovasculares, infecciosas y neoplásicas, y la lesión crónica del injerto por causas inmunológicas y no inmunológicas. Se ha atribuido al uso crónico de inhibidores de calcineurina (CNI, por su sigla en inglés), al aumento en el riesgo cardiovascular, a la incidencia de algunas infecciones y al aumento en la incidencia de neoplasias postrasplante. Igualmente, reportes en la literatura evidencian el aumento en la frecuencia de lesiones histológicas relacionadas con nefrotoxicidad por estos medicamentos, en la medida que el tiempo de exposición a los mismos aumenta. Se plantea que el cambio a esquemas basados en inhibidores mTOR puede disminuir alguno de estos efectos en el largo plazo. Por lo que se realizó un estudio de casos retrospectivo, de conversión tardía a inhibidores mTOR, en pacientes con esquema a base de CNI. Materiales y métodos:Se realizó un estudio de casos retrospectivo de centro único, incluyendo pacientes con más de 6 meses de trasplante renal, quienes fueron convertidos a everolimus despues de suspensión abrupta de CNI previa biopsia del injerto renal. Se excluyeron pacientes con evidencia en la biopsia de cambios de rechazo agudo, recaída de enfermedad glomerular o necrosis tubular aguda. Igualmente, se excluyeron pacientes con proteinuria >1 g en 24 horas y pacientes con rechazo agudo clínico en los 3 meses previos a la conversión. Se incluyeron un total de 40 pacientes, se realizó seguimiento posconversión de variables como tasa de filtración glomerular, proteinuria, lípidos, uso de hipotensores y efectos adversos, hasta el día 720 posconversión.

show abstract

Switch of immunosuppression from cyclosporine A to everolimus: impact on pulse wave velocity in stable de-novo renal allograft recipients

Cited by 52 publications

References 42 publications

A Longitudinal Study of Inflammation, CKD-Mineral Bone Disorder, and Carotid Atherosclerosis after Renal Transplantation

A Longitudinal Study of Inflammation, CKD-Mineral Bone Disorder, and Carotid Atherosclerosis after Renal Transplantation

Prediction of Cardiovascular Events After Renal Transplantation

24 month follow up to a late conversion from a calcineurin inhibitor regimen to everolimus in kidney transplant recipients

Contact Info

Product

Resources

About