2010 - TTS International Congress


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Complications Cardiovascular

31.17 - The Effect of Calcineurin Inhibitors and Mammalian Target of Rapamycine Inhibitors on Arterial Stiffness in Renal Transplant Patients

Presenter: Ender, Hur, Izmir, Turkey
Authors: Gungor O., Kircelli F., Hur E., Demirci M., Yildirim E., Asci G., Hoscoskun C., Toz H.

THE EFFECT OF CALCINEURIN INHIBITORS AND MAMMALIAN TARGET OF RAPAMYCINE INHIBITORS ON ARTERIAL STIFFNESS IN RENAL TRANSPLANT PATIENTS

COMPLICATIONS - CARDIOVASCULAR

O. Gungor1, F. Kircelli1, E. Hur1, M.S. Demirci1, E. Yildirim1, G. Asci1, C. Hoscoskun2, H. Toz1
1Nephrology, Ege University Medical School, Izmir/TURKEY, 2General Surgery, Ege University Medical School, Izmir/TURKEY

Body: Introduction: Cardiovascular diseases are the major causes of death after transplantation. Arterial stiffness is an established independent predictor of cardiovascular mortality and a risk marker for cardiovascular events. In this study we aimed to compare the effect of calcineurin inhibitors (CNI) and mammalian target of rapamycine inhibitors (mTORi) on arterial stiffness in renal transplant patients. Patients-Methods: Eighty-one kidney transplant patients, under CNI-based or mTORi-based protocol combined with mycophenolate mofetil and prednisolon for at least 6 months were included in the study. Demographical and clinical data were recorded from patients’ charts. Arterial stiffness was measured by the same operator by using Syphmocor device: augmentation index (AI) and femoral-carotid pulse wave velocity (f-c PWV) was determined. Vitamin K-dependent, calcification inhibitor matrix Gla protein (MGP) concentrations were quantified by ELISA methods (Biomedica, Viena, Austria). Results: Thirty-four patients were on mTORi-based and 47 on CNI-based immunosupression. Mean age was 37.9 ± 10.8 (18-71) years and 45% female. Demographical and clinical data are shown in the table. Age, gender, graft functions and post-transplant follow-up period of the groups were similar, except for higher lipid levels in patients on mTORi group. AI was 15.2±12.6 in CNI and 18.8±14.0 in mTORi groups (p>0.05). There was no difference regarding f-c PWV between groups (8.0±1.4 m/sn and 7.7±1.2 m/sn in CNI and mTORi groups, respectively) Arterial stiffness was positively correlated with age, total cholesterol, LDL, glucose, hs-CRP, mean arterial pressure (MAP) and proteinuria and negatively with albumin in univariate analysis. In multivariate analysis, MAP was the independent predictor for AI (p:0.002, Exp B:1.08) and proteinuria for f-c PWV (p: 0.02, ExpB: 1.05). Serum MGP levels were higher in mTORi group but was not a predictor for AI or f-c PWV.Conclusion: Rather than specific immunosuppressive drug effect, conventional riskfactors, blood pressure and proteinuria, are the most important predictors for arterial stiffness in kidney transplant patients. A slightly higher level of matrix Gla protein in mTORi-based treatmentneeds further clarification.Table: Demographical and clinical data

mTORi CNI p value
Age (years) 37.5±11.1 38.1±10.6 NS
Gender(male/female) 24/10 32/15 NS
Dialysis before transplant (month) 22.6±35.6 34.9±36.6 NS
Transplant duration (month) 43.7±27.4 44.8±37.4 NS
Mean arterial pressure (mmHg) 93±14 93±11 NS
eGFR (Cockroft Gault, ml/min) 52.5±17.1 59.1±19.6 NS
hs-CRP (mg/dl) 0.61±0.67 0.26±0.36 p<0.05
Proteinuria (gm/day 0.57±0.91 0.39±0.76 NS
Matrix Gla Protein (nmol/l) 14.75±4.35 12.80±3.17 p<0.05
Augmentation index (%) 18.8±14 15.2±12.6 NS
f-c PWV (m/sn) 7.7±1.2 8.0±1.4 NS


Disclosure: All authors have declared no conflicts of interest.


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