title: Conversion from calcineurin inhibitors to mTOR inhibitors stabilizes diabetic and hypertensive nephropathy after liver transplant.
abstract: OBJECTIVE
  To investigate if conversion to the mammalian target of rapamycin inhibitors (mTORi) improves renal function in diabetic and/or hypertensive liver transplant patients immunosuppressed with tacrolimus or cyclosporine.
  
  
  METHODS
  The study included 86 liver graft recipients immunosuppressed with mTORi treatment after orthotopic liver transplantation (OLT), including all liver recipients with worsening renal function before conversion to mTORi (n = 55 patients) and recipients with normal renal function who converted to mTORi for other reasons (n = 31 patients). We identified patients with diabetes mellitus (n = 28), arterial hypertension (n = 27), proteinuria (n = 27) and all three factors (n = 8) (some patients have hypertension and diabetes and no proteinuria). The primary endpoint was evolution in renal function defined as the development in plasma creatinine as a function of diabetes mellitus (DM), hypertension (HT) or proteinuria. We required elevated serum creatinine for at least two weeks to define renal dysfunction.
  
  
  RESULTS
  Only patients that converted because of renal failure with plasma creatinine levels > 1.5 mg/dL showed an improvement of renal function (2.14 to 1.77 mg/dL) (P = 0.02). Patients with DM showed no improvement of serum creatinine levels (1.31 mg/dL to 1.37 mg/dL) compared with non DM patients (1.31 mg/dL to 1.15 mg/dL) (P = 0.01), HT patients (1.48 mg/dL to 1.5 mg/dL) with non HT patients (1.21mg/dL to 1.08 mg/dL) and patients with proteinuria (1.44 mg/dL to 1.41 mg/dL) and no proteinuria (1.31 mg/dL to 1.11 mg/dL).
  
  
  CONCLUSIONS
  In OLT recipients with diabetes or hypertensive nephropathy, conversion to mTORi does not improve renal function but stabilizes plasma levels of creatinine. Proteinuria is not a contraindication to conversion to mTORi; it also stabilizes renal function. Conversion to mTORi should only be avoided in patients with diabetes, hypertension and proteinuria.
authors: José M Álamo, Unit of Liver Transplantation, Department of Surgery, University of Seville, 41013 Seville, Spain.
authors: José M
authors: JM
authors: Álamo
authors: José M Álamo, Unit of Liver Transplantation, Department of Surgery, University of Seville, 41013 Seville, Spain.
authors: Claudia
authors: C
authors: Olivares
authors: José M Álamo, Unit of Liver Transplantation, Department of Surgery, University of Seville, 41013 Seville, Spain.
authors: Lydia
authors: L
authors: Barrera
authors: José M Álamo, Unit of Liver Transplantation, Department of Surgery, University of Seville, 41013 Seville, Spain.
authors: Luis M
authors: LM
authors: Marín
authors: José M Álamo, Unit of Liver Transplantation, Department of Surgery, University of Seville, 41013 Seville, Spain.
authors: Gonzalo
authors: G
authors: Suarez
authors: José M Álamo, Unit of Liver Transplantation, Department of Surgery, University of Seville, 41013 Seville, Spain.
authors: Carmen
authors: C
authors: Bernal
authors: José M Álamo, Unit of Liver Transplantation, Department of Surgery, University of Seville, 41013 Seville, Spain.
authors: Juan
authors: J
authors: Serrano
authors: José M Álamo, Unit of Liver Transplantation, Department of Surgery, University of Seville, 41013 Seville, Spain.
authors: Jordi
authors: J
authors: Muntané
authors: José M Álamo, Unit of Liver Transplantation, Department of Surgery, University of Seville, 41013 Seville, Spain.
authors: Francisco J
authors: FJ
authors: Padillo
authors: José M Álamo, Unit of Liver Transplantation, Department of Surgery, University of Seville, 41013 Seville, Spain.
authors: Miguel A
authors: MA
authors: Gómez
keywords: Diabetes; Hypertension; Liver transplant; Mammalian target of rapamycin inhibitors; Renal dysfunction