CLINICAL IMMUNOSUPPRESSION - NEW AGENTS

H.A.H. Maamoun, E.A. Esmail, A.R. Soliman
Internal Medicine, cairo university, cairo/EGYPT

Body: INTRODUCTION : Endothelial dysfunction is of vital importance as it may cause ischemia and dysfunction in various organs especially heart and kidneys. Despite this problem has been well documented in patients with end-stage renal disease (ESRD), there is not enough data considering this issue for sirolimus use in renal transplantation. One of the potential causes of endothelial dysfunction in renal transplantation may be the use of the conventional protocols including cyclosporine A, CsA and tacrolimus. The effect of sirolimus based therapy on endothelial function in renal transplant patients is not well studied.
METHODS: Twenty two renal transplant recipients (14 on CsA, group I and 8 on sirolimus, group II) were studied. Endothelial functions of the brachial artery were evaluated by using high resolution vascular ultrasound. Endothelium-dependent and independent vasodilatations were assessed by using sublingual nitroglycerine (NTG).
RESULTS: Results are presented as percentage from baseline values.Significant endothelial dysfunction was noted in renal transplant patients treated with CsA. While endothelium dependent vasodilatation was 14.5±3.2 % in group I, it was 3.6±2.8 % in group II (p <0.002). The increase in brachial artery diameter after sublingual NTG was 22.1±5.9 and 9.9±4.7 % in group I and group II, respectively.
CONCLUSIONS: Endothelial vasodilatation of patients on sirolimus is preserved than patients on CsA therapy. We can conclude that endothelial vasodilatation is impaired in renal transplants. Moreover, Sirolimus is more useful than CsA in compromised vasculature as in diabetic and elderly patients.

Disclosure: All authors have declared no conflicts of interest.