Effect of Sirolimus on Left Ventricular Hypertrophy in Kidney Transplant Recipients: A 1-Year Nonrandomized Controlled Trial

Paoletti, Ernesto; Amidone, Marco; Cassottana, Paolo; Gherzi, Maurizio; Marsano, Luigina; Cannella, Giuseppe

doi:10.1053/j.ajkd.2008.04.018

« Previous Next »American Journal of Kidney Diseases
Volume 52, Issue 2 , Pages 324-330, August 2008

Effect of Sirolimus on Left Ventricular Hypertrophy in Kidney Transplant Recipients: A 1-Year Nonrandomized Controlled Trial

Ernesto Paoletti, MD
- Divisione di Nefrologia, Dialisi, e Trapianto, Azienda Ospedaliera Universitaria S Martino, Genova, Italy
- Address correspondence to Ernesto Paoletti, MD, Divisione di Nefrologia, Dialisi, e Trapianto, Azienda Ospedaliera Universitaria S Martino, Lgo R Benzi 10, 16132, Genova, Italy.
Marco Amidone, MD
- Divisione di Nefrologia, Dialisi, e Trapianto, Azienda Ospedaliera Universitaria S Martino, Genova, Italy
Paolo Cassottana, MD
- Divisione di Cardiologia, Azienda Ospedaliera Universitaria S Martino, Genova, Italy.
Maurizio Gherzi, MD
- Divisione di Nefrologia, Dialisi, e Trapianto, Azienda Ospedaliera Universitaria S Martino, Genova, Italy
Luigina Marsano, MD
- Divisione di Nefrologia, Dialisi, e Trapianto, Azienda Ospedaliera Universitaria S Martino, Genova, Italy
Giuseppe Cannella, MD, PhD
- Divisione di Nefrologia, Dialisi, e Trapianto, Azienda Ospedaliera Universitaria S Martino, Genova, Italy

Received 1 January 2008; accepted 23 April 2008. published online 01 July 2008.

Background

Left ventricular hypertrophy (LVH) after renal transplantation may be affected by immunosuppressive therapy.

Study Design

Nonrandomized controlled trial evaluating the effect of sirolimus (SRL) on LVH of renal transplant recipients (RTRs).

Setting & Participants

13 RTRs without diabetes who had received a single-kidney transplant from a deceased donor with chronic allograft dysfunction and biopsy-proven allograft nephropathy who were converted from calcineurin-inhibitor (CNI) to SRL treatment; 26 controls matched for age and year of transplantation who were not converted from CNI to SRL treatment.

Intervention

Conversion from CNI to SRL therapy.

Outcomes & Measurements

Left ventricular mass determination by using echocardiography at baseline and again 1 year later. Blood pressure (BP), hemoglobin level, serum creatinine level, uric acid level, lipid levels, trough levels of immunosuppressive drugs, and daily proteinuria were assessed at least twice monthly. Conventional antihypertensive therapy was used to achieve BP of 130/80 mm Hg or less.

Results

The study population included 26 men and 13 women (age, 25 to 66 years). Changes in BP were similar in the 2 groups (between-group difference, −4 ± 5 mm Hg; P = 0.5 for systolic BP; −2 ± 3; P = 0.6 for diastolic BP), whereas left ventricular mass significantly decreased in the SRL group alone (between-group difference, 8.6 ± 2.4 g/m^2.7; P < 0.001) because of a decrease in both the interventricular septum and left ventricular posterior wall. LVH regressed in 12 of 13 patients on SRL therapy and 10 of 26 controls (P = 0.002).

Limitations

Nonrandomized design. Single-center study with small sample size.

Conclusions

Conversion from CNI to SRL therapy may regress LVH in RTRs regardless of BP changes, mainly by decreasing left ventricular wall thickness, thus suggesting nonhemodynamic-effect mechanisms of SRL on left ventricular mass.

Index Words: Left ventricular hypertrophy (LVH), renal transplant recipients, sirolimus, calcineurin inhibitors