Effect of Calcineurin Inhibitor–Free, Everolimus-Based Immunosuppressive Regimen on Albuminuria and Glomerular Filtration Rate After Heart Transplantation
| Autor: | Finn Gustafsson, Göran Dellgren, Hans Eiskjær, Einar Gude, Bert Andersson, Arne K. Andreassen, Göran Rådegran, Lars Gullestad, Lærke Marie Nelson |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Calcineurin Inhibitors 030232 urology & nephrology Urology Renal function Scandinavian and Nordic Countries 030230 surgery Kidney Drug Administration Schedule 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Journal Article Albuminuria Humans Medicine Everolimus Prospective Studies Prospective cohort study Heart transplantation Transplantation Creatinine business.industry Immunosuppression Middle Aged Surgery Calcineurin Treatment Outcome chemistry Heart Transplantation Drug Therapy Combination Female medicine.symptom business Immunosuppressive Agents Glomerular Filtration Rate medicine.drug |
| Zdroj: | Nelson, L M, Andreassen, A K, Andersson, B, Gude, E, Eiskjær, H, Rådegran, G, Dellgren, G, Gullestad, L & Gustafsson, F 2017, ' Effect of Calcineurin Inhibitor-Free Everolimus-Based Immunosuppressive Regimen on Albuminuria and Glomerular Filtration Rate after Heart Transplantation ', Transplantation, vol. 101, no. 11, pp. 2793-2800 . https://doi.org/10.1097/TP.0000000000001706 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000001706 |
| Popis: | Albuminuria in maintenance heart transplantation (HTx) is associated with poor renal response when switching to a calcineurin inhibitor (CNI)-lowered or CNI-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.We tested if measured glomerular filtration rate (mGFR, by chrome-ethylenediaminetetraacetic acid clearance) was associated with urine albumin/creatinine ratio (UACR) post-HTx in a subgroup of patients included in the Scandinavian Heart Transplant Everolimus De Novo Study With Early Calcineurin Inhibitor Avoidance trial, where de novo HTx patients (n = 115) were randomized to EVR with complete CNI elimination 7 to 11 weeks post-HTx or standard CNI immunosuppression.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 and P = 0.03, respectively). 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 and r = 0.15, P = 0.26, respectively) and in the EVR group 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.The effects of EVR with early CNI withdrawal after HTx on albuminuria and renal function seem dissociated; hence, the clinical significance of albuminuria in this setting is uncertain and should not necessarily rule out EVR-based immunosuppression. |
| Databáze: | OpenAIRE |
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