Cardiac response to early conversion from calcineurin inhibitor to everolimus in renal transplant recipients--a three-yr serial echocardiographic substudy of the randomized controlled CENTRAL trial

Clin Transplant. 2015 Aug;29(8):678-84. doi: 10.1111/ctr.12565. Epub 2015 Jun 17.

Abstract

Background: In transplant recipients, calcineurin inhibitors (CNIs) are associated with adverse cardiac effects while mTOR inhibitors have been reported to be beneficial. We performed a randomized controlled trial (RCT) in de novo renal transplant recipients examining cardiac responses of everolimus vs. CNI.

Methods: This was a substudy of the three-yr CENTRAL study, an RCT on safety and efficacy of early (week 7 post-engraftment) conversion from cyclosporine A (CsA) to everolimus vs. continued CsA. Thirty-nine recipients [median age 64 yr, (range 31-81)] completed echocardiographic evaluations at baseline, one, and three yr.

Results: After three yr, there was no difference between groups in left ventricle (LV) diastolic function, LV systolic function, LV morphology, and blood pressure response. We observed a relevant decrease in LV mass (CsA; 9.6%, p = 0.008, vs. everolimus; 7.0% reduction, p = 0.15), stabilized LV diastolic function, and a trend toward lower systolic blood pressure with 6 mmHg decrease in both arms (CsA, p = 0.08; everolimus, p = 0.14). Diastolic blood pressure was significantly reduced (8 mmHg decrease, p = 0.002) only in everolimus patients.

Conclusions: After three-yr follow-up, no clinically relevant effect on cardiac function of an early conversion from CsA to an everolimus-based immunosuppressive regimen was detected in de novo renal transplant recipients.

Keywords: calcineurin inhibitor; cardiovascular disease; echocardiography; everolimus; kidney transplantation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Pressure Determination
  • Calcineurin Inhibitors / therapeutic use*
  • Diastole / drug effects
  • Echocardiography
  • Everolimus / therapeutic use*
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Survival
  • Heart / drug effects*
  • Heart Diseases / prevention & control*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Failure, Chronic / surgery*
  • Kidney Function Tests
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Prognosis
  • Risk Factors
  • Systole / drug effects
  • Transplant Recipients

Substances

  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Everolimus