MP52-09 CARDIAC FUNCTION IMPROVEMENT IN KIDNEY TRANSPLANTS PATIENTS AFTER THE EARLY ADDITION OF EVEROLIMUS WITH CALCINEURIN INHIBITOR MINIMIZATION

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II (MP52)1 Apr 2020MP52-09 CARDIAC FUNCTION IMPROVEMENT IN KIDNEY TRANSPLANTS PATIENTS AFTER THE EARLY ADDITION OF EVEROLIMUS WITH CALCINEURIN INHIBITOR MINIMIZATION Naoki Yokoyama*, Takeshi Ishimura, Takahito Endo, Shun Nishioka, Teruyuki Oda, Satoshi Ogawa, and Masato Fujisawa Naoki Yokoyama*Naoki Yokoyama* More articles by this author , Takeshi IshimuraTakeshi Ishimura More articles by this author , Takahito EndoTakahito Endo More articles by this author , Shun NishiokaShun Nishioka More articles by this author , Teruyuki OdaTeruyuki Oda More articles by this author , Satoshi OgawaSatoshi Ogawa More articles by this author , and Masato FujisawaMasato Fujisawa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000914.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with chronic kidney disease, cardiac function has been shown to improve after kidney transplantation (KTx) in accordance with kidney function recovery. In contrast, KTx patients are exposed to de novo risk factors for cardiac dysfunction such as calcineurin inhibitors (CNIs). Recently, everolimus (EVR)-based CNI-minimization regimens have been reported to reduce cardiac abnormalities during heart transplants. Moreover, EVR itself has been reported to confer direct cardioprotective effects. However, the details concerning the long-term effects of KTx have not been elucidated. METHODS: This study included 75 patients who underwent KTx and were initially treated with CNI, mycophenolate mofetil, and methylprednisolone between 2010 and 2016. Thirty-seven patients started to receive EVR along with a CNI reduction 3 months after KTx (EVR group) and 38 patients were continued on CNI-based immunosuppression without EVR (CNI group). All patients underwent echocardiography before, and at 3 months and 3 years after KTx. We analyzed several parameters such as ejection fraction (EF), left ventricular diastolic diameter (LVDd), and left ventricular mass index (LVMI, g/m2) and compared these parameters between groups. Additionally, we regarded patients who had an LVMI≥125 and ≥110 in male and females, respectively, as having left ventricular hypertrophy (LVH). The prevalence of LVH was also compared between the EVR and CNI groups. RESULTS: The EF and LVDd did not show any apparent changes from pre-KTx to 3 years after KTx. The mean LVMI before, and at 3 months and 3 years after KTx were 118.7 ± 54.7, 102.1 ± 23.3, and 100.6 ± 23.7, respectively. We observed significant improvements in LVMI values from pre-KTx to 3 months after KTx (p=0.02). The change in LVMI values and prevalence of LVH did not show any differences between the EVR and CNI groups. Since the change in LVMI values of patients who already had LVH 3 months after KTx tended to be considerably affected by kidney function improvements regardless of immunosuppressant, we performed a subgroup analysis on 62 patients without LVH at 3 months after KTx. The LVMI in the EVR group showed greater improvement than the CNI group (-1.7 ± 21.5 vs 9.2 ± 18.4, p=0.03) and the ratio of patients with LVH was significantly higher in the EVR group than in the CNI group 3 years after KTx (5.8% vs 21.4%, p=0.05). CONCLUSIONS: The early addition of EVR and reduction of CNI after KTx may reduce myocardial hypertrophy and improve long-term cardiac function. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e775-e775 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naoki Yokoyama* More articles by this author Takeshi Ishimura More articles by this author Takahito Endo More articles by this author Shun Nishioka More articles by this author Teruyuki Oda More articles by this author Satoshi Ogawa More articles by this author Masato Fujisawa More articles by this author Expand All Advertisement PDF downloadLoading ...