title: Cardiac response to early conversion from calcineurin inhibitor to everolimus in renal transplant recipients--a three-yr serial echocardiographic substudy of the randomized controlled CENTRAL trial.
abstract: BACKGROUND
  In transplant recipients, calcineurin inhibitors (CNIs) are associated with adverse cardiac effects while mTOR inhibitors have been reported to be beneficial. We performed a randomized controlled trial (RCT) in de novo renal transplant recipients examining cardiac responses of everolimus vs. CNI.
  
  
  METHODS
  This was a substudy of the three-yr CENTRAL study, an RCT on safety and efficacy of early (week 7 post-engraftment) conversion from cyclosporine A (CsA) to everolimus vs. continued CsA. Thirty-nine recipients [median age 64 yr, (range 31-81)] completed echocardiographic evaluations at baseline, one, and three yr.
  
  
  RESULTS
  After three yr, there was no difference between groups in left ventricle (LV) diastolic function, LV systolic function, LV morphology, and blood pressure response. We observed a relevant decrease in LV mass (CsA; 9.6%, p = 0.008, vs. everolimus; 7.0% reduction, p = 0.15), stabilized LV diastolic function, and a trend toward lower systolic blood pressure with 6 mmHg decrease in both arms (CsA, p = 0.08; everolimus, p = 0.14). Diastolic blood pressure was significantly reduced (8 mmHg decrease, p = 0.002) only in everolimus patients.
  
  
  CONCLUSIONS
  After three-yr follow-up, no clinically relevant effect on cardiac function of an early conversion from CsA to an everolimus-based immunosuppressive regimen was detected in de novo renal transplant recipients.
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.
authors.forename: Klaus
authors.initials: K
authors.lastname: Murbraech
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.
authors.forename: Richard
authors.initials: R
authors.lastname: Massey
authors.affiliation: Department of Medicine, Baerum County Hospital, Baerum, Norway.
authors.forename: Liv H
authors.initials: LH
authors.lastname: Undset
authors.affiliation: Department of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Norway.
authors.forename: Karsten
authors.initials: K
authors.lastname: Midtvedt
authors.affiliation: Department of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Norway.
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001795:Blood Pressure Determination; D065095:Calcineurin Inhibitors / Q000627:therapeutic use*; D003971:Diastole / Q000187:drug effects; D004452:Echocardiography; D000068338:Everolimus / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006321:Heart / Q000187:drug effects*; D006331:Heart Diseases / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013599:Systole / Q000187:drug effects; D066027:Transplant Recipients
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus
keywords: calcineurin inhibitor; cardiovascular disease; echocardiography; everolimus; kidney transplantation