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14. Regression of cardiac growth in kidney transplant recipients using anti-m-TOR drugs plus RAS blockers: a controlled longitudinal study

Author

Eva Briceño, Domingo Hernández, Mercedes Cabello, Manuel De Mora, Eulalia Palma, Dolores Burgos, Auxiliadora Mazuecos, Daniel Gaitán, Rocío Collantes, Pedro Ruiz-Esteban, M. Gonzalez-Molina, [Hernández,D, Ruiz-Esteban,P, Burgos,D, Palma,E, Cabello,M, González-Molina,M] Department of Nephrology, Carlos Haya University Hospital and IBIMA, Malaga, Spain. [Gaitán,D, De Mora,M] Department of Cardiology and Radiology, Carlos Haya University Hospital and IBIMA, Malaga, Spain. [Briceño,E] Department of Radiology, Carlos Haya University Hospital and IBIMA, Malaga, Spain. [Mazuecos,A, Collantes,R] Department of Nephrology, Hospital Puerta del Mar, Cadiz, Spain., and This study was supported by grant PI-0499/2009 from the Consejería de Salud del Gobierno de Andalucía and, in part, by the Spanish Ministry of Science and Innovation (MICINN) (Grant no. PI10/01020) from the Instituto de Salud Carlos III, RETIC, REDinREN RD12/0021/0015.

Subjects
Male, Nephrology, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Enzyme Inhibitors::Protein Kinase Inhibitors [Medical Subject Headings], Angiotensin-Converting Enzyme Inhibitors, Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings], Left ventricular hypertrophy, Kidney transplantation, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Trasplante de riñón, Inhibidores de proteínas cinasas, Longitudinal Studies, TOR Serine-Threonine Kinases, TOR serina-treonina cinasas, Middle Aged, Treatment Outcome, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Transplantation::Organ Transplantation::Kidney Transplantation [Medical Subject Headings], Cardiology, Drug Therapy, Combination, Female, Hypertrophy, Left Ventricular, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Angiotensin Receptor Antagonists [Medical Subject Headings], Inhibidores de la enzima convertidora de angiotensina, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Immunologic Factors::Immunosuppressive Agents [Medical Subject Headings], Immunosuppressive Agents, Research Article, medicine.medical_specialty, Diastole, Hipertrofia ventricular izquierda, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Drug Therapy, Combination [Medical Subject Headings], Check Tags::Male [Medical Subject Headings], Antagonistas de receptores de angiotensina, Angiotensin Receptor Antagonists, Pharmacotherapy, Internal medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies [Medical Subject Headings], medicine, Humans, Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Intracellular Signaling Peptides and Proteins::TOR Serine-Threonine Kinases [Medical Subject Headings], Everolimus, Protein Kinase Inhibitors, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings], Sirolimus, business.industry, medicine.disease, Inmunosupresores, Kidney Transplantation, Renin-angiotensin blockers, Calcineurin, Left ventricular hupertrophy, Endocrinology, Blood pressure, Diseases::Pathological Conditions, Signs and Symptoms::Pathological Conditions, Anatomical::Hypertrophy::Cardiomegaly::Hypertrophy, Left Ventricular [Medical Subject Headings], Farmacoterapia combinada, Check Tags::Female [Medical Subject Headings], Resultado del tratamiento, Complication, business, Renin-angiotensis blockers, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Enzyme Inhibitors::Protease Inhibitors::Angiotensin-Converting Enzyme Inhibitors [Medical Subject Headings]
Abstract

Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; BACKGROUND Left ventricular hypertrophy (LVH) is common in kidney transplant (KT) recipients. LVH is associated with a worse outcome, though m-TOR therapy may help to revert this complication. We therefore conducted a longitudinal study to assess morphological and functional echocardiographic changes after conversion from CNI to m-TOR inhibitor drugs in nondiabetic KT patients who had previously received RAS blockers during the follow-up. METHODS We undertook a 1-year nonrandomized controlled study in 30 non-diabetic KT patients who were converted from calcineurin inhibitor (CNI) to m-TOR therapy. A control group received immunosuppressive therapy based on CNIs. Two echocardiograms were done during the follow-up. RESULTS Nineteen patients were switched to SRL and 11 to EVL. The m-TOR group showed a significant reduction in LVMi after 1 year (from 62 ± 22 to 55 ± 20 g/m2.7; P=0.003, paired t-test). A higher proportion of patients showing LVMi reduction was observed in the m-TOR group (53.3 versus 29.3%, P=0.048) at the study end. In addition, only 56% of the m-TOR patients had LVH at the study end compared to 77% of the control group (P=0.047). A significant change from baseline in deceleration time in early diastole was observed in the m-TOR group compared with the control group (P=0.019). CONCLUSIONS Switching from CNI to m-TOR therapy in non-diabetic KT patients may regress LVH, independently of blood pressure changes and follow-up time. This suggests a direct non-hemodynamic effect of m-TOR drugs on cardiac mass. Yes

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