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Effect of Calcineur...
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Nelson, Lærke M.University of Oslo,Oslo university hospital
(author)
Effect of Calcineurin Inhibitor-Free Everolimus-Based Immunosuppressive Regimen on Albuminuria and Glomerular Filtration Rate after Heart Transplantation
- Article/chapterEnglish2017
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LIBRIS-ID:oai:lup.lub.lu.se:de5c6761-e706-4cf2-adb4-0c41d7ffbe5b
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https://lup.lub.lu.se/record/de5c6761-e706-4cf2-adb4-0c41d7ffbe5bURI
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https://doi.org/10.1097/TP.0000000000001706DOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:art swepub-publicationtype
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Subject category:ref swepub-contenttype
Notes
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BACKGROUND: Albuminuria in maintenance heart transplantation (HTx) is associated with poor renal response when switching to a calcineurin inhibitor (CNI)-lowered or free immunosuppressive regimen using everolimus (EVR), but the significance of albuminuria associated with EVR treatment after early CNI withdrawal in de novo HTx is unknown. METHODS: We tested if glomerular filtration rate (mGFR, measured by CrEDTA clearance) was associated with urine albumin/creatinine ratio (UACR) post-HTx in a subgroup of patients included in the SCHEDULE trial, where de novo HTx patients (n=115) were randomized to EVR with complete CNI elimination 7–11 weeks post-HTx or standard CNI immunosuppression. RESULTS: In 66 patients UACR measures were available at 1 year. In 7 patients in the EVR group a CNI was reintroduced within 12 months. Median mGFR was significantly higher in the EVR group both 1 and 3 years post-HTx (p=0.0004, p=0.03). Median UACR at 1 year was significantly higher in the EVR group (p=0.002). There was no correlation between log(UACR) at 1 year and mGFR at 1 or 3 years (r=−0.01, p=0.9; r=0.15, p=0.26), and in the EVR group nor between log(UACR) at 1 year and change in mGFR (Δ1-3 years) (r=0.27, p=0.14). Excluding patients in the EVR group in whom a CNI was reintroduced did not significantly change the results. CONCLUSIONS: The effects of EVR with early CNI withdrawal after HTx on albuminuria and renal function appear dissociated; hence the clinical significance of albuminuria in this setting is uncertain and should not necessarily rule out EVR-based immunosuppression.
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Andreassen, Arne K.Oslo university hospital
(author)
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Andersson, BertSahlgrenska University Hospital
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Gude, EinarOslo university hospital
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Eiskjær, HansAarhus University Hospital
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Rådegran, GöranLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Lund Hemodynamic Lab,Forskargrupper vid Lunds universitet,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University Research Groups,Skåne University Hospital(Swepub:lu)med-grd
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Dellgren, GöranUniversity of Gothenburg,Sahlgrenska University Hospital
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Gullestad, LarsUniversity of Oslo,Oslo university hospital
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Gustafsson, FCopenhagen University Hospital
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University of OsloOslo university hospital
(creator_code:org_t)
Related titles
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In:Transplantation101:11, s. 2793-28000041-1337
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