Effect of sirolimus on left ventricular hypertrophy in kidney transplant recipients: a 1-year nonrandomized controlled trial

E Paoletti, M Amidone, P Cassottana, M Gherzi… - American journal of …, 2008 - Elsevier
E Paoletti, M Amidone, P Cassottana, M Gherzi, L Marsano, G Cannella
American journal of kidney diseases, 2008Elsevier
BACKGROUND: Left ventricular hypertrophy (LVH) after renal transplantation may be
affected by immunosuppressive therapy. STUDY DESIGN: Nonrandomized controlled trial
evaluating the effect of sirolimus (SRL) on LVH of renal transplant recipients (RTRs).
SETTING & PARTICIPANTS: 13 RTRs without diabetes who had received a single-kidney
transplant from a deceased donor with chronic allograft dysfunction and biopsy-proven
allograft nephropathy who were converted from calcineurin-inhibitor (CNI) to SRL treatment; …
BACKGROUND
Left ventricular hypertrophy (LVH) after renal transplantation may be affected by immunosuppressive therapy.
STUDY DESIGN
Nonrandomized controlled trial evaluating the effect of sirolimus (SRL) on LVH of renal transplant recipients (RTRs).
SETTING & PARTICIPANTS
13 RTRs without diabetes who had received a single-kidney transplant from a deceased donor with chronic allograft dysfunction and biopsy-proven allograft nephropathy who were converted from calcineurin-inhibitor (CNI) to SRL treatment; 26 controls matched for age and year of transplantation who were not converted from CNI to SRL treatment.
INTERVENTION
Conversion from CNI to SRL therapy.
OUTCOMES & MEASUREMENTS
Left ventricular mass determination by using echocardiography at baseline and again 1 year later. Blood pressure (BP), hemoglobin level, serum creatinine level, uric acid level, lipid levels, trough levels of immunosuppressive drugs, and daily proteinuria were assessed at least twice monthly. Conventional antihypertensive therapy was used to achieve BP of 130/80 mm Hg or less.
RESULTS
The study population included 26 men and 13 women (age, 25 to 66 years). Changes in BP were similar in the 2 groups (between-group difference, −4 ± 5 mm Hg; P = 0.5 for systolic BP; −2 ± 3; P = 0.6 for diastolic BP), whereas left ventricular mass significantly decreased in the SRL group alone (between-group difference, 8.6 ± 2.4 g/m2.7; P < 0.001) because of a decrease in both the interventricular septum and left ventricular posterior wall. LVH regressed in 12 of 13 patients on SRL therapy and 10 of 26 controls (P = 0.002).
LIMITATIONS
Nonrandomized design. Single-center study with small sample size.
CONCLUSIONS
Conversion from CNI to SRL therapy may regress LVH in RTRs regardless of BP changes, mainly by decreasing left ventricular wall thickness, thus suggesting nonhemodynamic-effect mechanisms of SRL on left ventricular mass.
Elsevier