Effect of Calcineurin Inhibitor-Free Everolimus-Based Immunosuppressive Regimen on Albuminuria and Glomerular Filtration Rate after Heart Transplantation

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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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2017

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LIBRIS-ID:oai:lup.lub.lu.se:de5c6761-e706-4cf2-adb4-0c41d7ffbe5b
https://lup.lub.lu.se/record/de5c6761-e706-4cf2-adb4-0c41d7ffbe5bURI
https://doi.org/10.1097/TP.0000000000001706DOI

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Language:English
Summary in:English

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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)
Andersson, BertSahlgrenska University Hospital (author)
Gude, EinarOslo university hospital (author)
Eiskjær, HansAarhus University Hospital (author)
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 (author)
Dellgren, GöranUniversity of Gothenburg,Sahlgrenska University Hospital (author)
Gullestad, LarsUniversity of Oslo,Oslo university hospital (author)
Gustafsson, FCopenhagen University Hospital (author)
University of OsloOslo university hospital (creator_code:org_t)

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In:Transplantation101:11, s. 2793-28000041-1337

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By the author/editor: Nelson, Lærke M.; Andreassen, Arne ...; Andersson, Bert; Gude, Einar; Eiskjær, Hans; Rådegran, Göran; show more...; Dellgren, Göran; Gullestad, Lars; Gustafsson, F; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

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By the university: Lund University

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