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Effect of everolimus on left ventricular hypertrophy of de novo kidney transplant recipients: a 1 year, randomized, controlled trial.
Transplantation. 2012 Mar 15; 93(5):503-8.T

Abstract

BACKGROUND

Although conversion from calcineurin inhibitors to mammalian target of rapamycin inhibitors proved to be effective in regressing left ventricular hypertrophy (LVH) in renal transplant recipients (RTRs) with chronic allograft dysfunction, there are currently no reports of randomized trials on this issue involving de novo RTRs administered everolimus (EVL).

METHODS

This randomized, open-label, controlled trial evaluated the effect of EVL on the left ventricular mass index (LVMi) of 30 nondiabetic RTRs (21 men; age 28-65 years). Ten were allocated to EVL plus reduced-exposure cyclosporine A (CsA), and 20 to standard dose CsA. LVMi was assessed by echocardiography both at baseline and 1 year later. Blood pressure (BP), hemoglobin, serum creatinine, lipids, trough levels of immunosuppressive drugs, and daily proteinuria were also evaluated twice monthly. Antihypertensive therapy that did not include renin-angiotensin system blockers was administered to achieve BP less than or equal to 130/80 mm Hg.

RESULTS

Changes in BP were similar in the two groups (between group difference 1.2 ± 5.7 mm Hg, P=0.84 for systolic, and -1.5 ± 3.7, P=0.69, for diastolic BP), whereas LVMi significantly decreased in the EVL group alone (between group difference 9.2 ± 3.1 g/m(2.7), P=0.005), due to a reduction in both the interventricular septum and the left ventricular posterior wall thickness. EVL therapy together with baseline LVMi were the only significant predictors of LVH regression according to a multivariate model that explained 49% of the total LVMi variance (P=0.0015).

CONCLUSIONS

An immunosuppressive regimen consisting of EVL plus reduced exposure CsA proved to be effective in regressing LVH in RTRs regardless of BP, mainly by reducing left ventricular wall thickness.

Authors+Show Affiliations

Division of Nephrology, Dialysis and Transplantation, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy. ernesto.paoletti@hsanmartino.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

22318246

Citation

Paoletti, Ernesto, et al. "Effect of Everolimus On Left Ventricular Hypertrophy of De Novo Kidney Transplant Recipients: a 1 Year, Randomized, Controlled Trial." Transplantation, vol. 93, no. 5, 2012, pp. 503-8.
Paoletti E, Marsano L, Bellino D, et al. Effect of everolimus on left ventricular hypertrophy of de novo kidney transplant recipients: a 1 year, randomized, controlled trial. Transplantation. 2012;93(5):503-8.
Paoletti, E., Marsano, L., Bellino, D., Cassottana, P., & Cannella, G. (2012). Effect of everolimus on left ventricular hypertrophy of de novo kidney transplant recipients: a 1 year, randomized, controlled trial. Transplantation, 93(5), 503-8. https://doi.org/10.1097/TP.0b013e318242be28
Paoletti E, et al. Effect of Everolimus On Left Ventricular Hypertrophy of De Novo Kidney Transplant Recipients: a 1 Year, Randomized, Controlled Trial. Transplantation. 2012 Mar 15;93(5):503-8. PubMed PMID: 22318246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of everolimus on left ventricular hypertrophy of de novo kidney transplant recipients: a 1 year, randomized, controlled trial. AU - Paoletti,Ernesto, AU - Marsano,Luigina, AU - Bellino,Diego, AU - Cassottana,Paolo, AU - Cannella,Giuseppe, PY - 2012/2/10/entrez PY - 2012/2/10/pubmed PY - 2012/4/17/medline SP - 503 EP - 8 JF - Transplantation JO - Transplantation VL - 93 IS - 5 N2 - BACKGROUND: Although conversion from calcineurin inhibitors to mammalian target of rapamycin inhibitors proved to be effective in regressing left ventricular hypertrophy (LVH) in renal transplant recipients (RTRs) with chronic allograft dysfunction, there are currently no reports of randomized trials on this issue involving de novo RTRs administered everolimus (EVL). METHODS: This randomized, open-label, controlled trial evaluated the effect of EVL on the left ventricular mass index (LVMi) of 30 nondiabetic RTRs (21 men; age 28-65 years). Ten were allocated to EVL plus reduced-exposure cyclosporine A (CsA), and 20 to standard dose CsA. LVMi was assessed by echocardiography both at baseline and 1 year later. Blood pressure (BP), hemoglobin, serum creatinine, lipids, trough levels of immunosuppressive drugs, and daily proteinuria were also evaluated twice monthly. Antihypertensive therapy that did not include renin-angiotensin system blockers was administered to achieve BP less than or equal to 130/80 mm Hg. RESULTS: Changes in BP were similar in the two groups (between group difference 1.2 ± 5.7 mm Hg, P=0.84 for systolic, and -1.5 ± 3.7, P=0.69, for diastolic BP), whereas LVMi significantly decreased in the EVL group alone (between group difference 9.2 ± 3.1 g/m(2.7), P=0.005), due to a reduction in both the interventricular septum and the left ventricular posterior wall thickness. EVL therapy together with baseline LVMi were the only significant predictors of LVH regression according to a multivariate model that explained 49% of the total LVMi variance (P=0.0015). CONCLUSIONS: An immunosuppressive regimen consisting of EVL plus reduced exposure CsA proved to be effective in regressing LVH in RTRs regardless of BP, mainly by reducing left ventricular wall thickness. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/22318246/Effect_of_everolimus_on_left_ventricular_hypertrophy_of_de_novo_kidney_transplant_recipients:_a_1_year_randomized_controlled_trial_ L2 - https://doi.org/10.1097/TP.0b013e318242be28 DB - PRIME DP - Unbound Medicine ER -