title: Contrast enhanced sonography shows superior microvascular renal allograft perfusion in patients switched from cyclosporine A to everolimus.
abstract: BACKGROUND
  Real-time contrast enhanced sonography (CES) provides quantitative information on microvascular tissue perfusion in renal allografts. In contrast to calcineurin inhibitors, mammalian target of rapamycin inhibitors may have beneficial effects on renal microvascular tissue perfusion. There is no information on the microperfusion of renal allografts in patients receiving either mammalian target of rapamycin inhibitor or calcineurin inhibitor.
  
  
  METHODS
  In a prospective randomized, clinical trial, renal parenchymal tissue perfusion of 24 stable renal allograft recipients was evaluated with CES. Eleven patients were kept on cyclosporine A (CsA); 13 were converted to everolimus (EVR). Measurements were made at the time of the switch from CsA to EVR, 8.21+/-6.36 months posttransplantation, and 21.2+/-6.57 months posttransplantation. In addition to laboratory and clinical parameters, Doppler indices and estimated glomerular filtration rate (eGFR) were measured. RESULTS.: After the switch from CsA to EVR, microvascular perfusion in the EVR-treated patients (Axbeta value at baseline 9.23+/-7.44 dB/sec, Axbeta value at time of follow-up 19.6+/-13.0 dB/sec, P=0.03) and the estimated GFR (81.2+/-20.3 and 96.9+/-22.6 mL/min, P=0.001) improved significantly. Microvascular perfusion (Axbeta 7.04+/-5.32 dB/sec and Axbeta 8.66+/-9.01 dB/sec, P=0.34) and the eGFR of the group continuing CsA treatment remained stable (78.5+/-25.9 and 73.2+/-37.3 mL/min, P=0.1).
  
  
  CONCLUSIONS
  The study demonstrates that renal microperfusion visualized by CES based on microbubble contrast agent and concomitantly kidney function, improved significantly after the switch from CsA to EVR.
authors.affiliation: Department of Nephrology, University of Heidelberg, 69120 Heidelberg, Germany. lars.kihm@med.uni-heidelberg.de
authors.forename: Lars P
authors.initials: LP
authors.lastname: Kihm
authors.forename: Ulrich-Paul
authors.initials: UP
authors.lastname: Hinkel
authors.forename: Kayla
authors.initials: K
authors.lastname: Michael
authors.forename: Claudia
authors.initials: C
authors.lastname: Sommerer
authors.forename: Joerg
authors.initials: J
authors.lastname: Seckinger
authors.forename: Christian
authors.initials: C
authors.lastname: Morath
authors.forename: Martin
authors.initials: M
authors.lastname: Zeier
authors.forename: Vedat
authors.initials: V
authors.lastname: Schwenger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D000068338:Everolimus; D005919:Glomerular Filtration Rate; D006801:Humans; D007089:Image Enhancement; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000502:physiology*; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology*; D008875:Middle Aged; D012079:Renal Circulation / Q000187:drug effects / Q000502:physiology*; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014463:Ultrasonography / Q000379:methods; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000068338:Everolimus; D003404:Creatinine; D020123:Sirolimus