Cardiac response to early conversion from calcineurin inhibitor to everolimus in renal transplant recipients: an echocardiographic substudy of the randomized controlled CENTRAL trial

Abstract

Background: Calcineurin inhibitors are associated with adverse cardiac effects. Mammalian target of rapamycin inhibitors have been reported to have beneficial effects on cardiac function. We used advanced echocardiographic techniques in a randomized controlled trial to examine cardiac responses to an everolimus-based arm versus a calcineurin inhibitor-based arm in de novo kidney transplant recipients.

Methods: This was a substudy of the Certican Nordic Trial in Renal Transplantation study, a randomized controlled trial on safety and efficacy of early (week 7 after renal transplantation) conversion from cyclosporine A (CsA) to everolimus versus continued CsA during 1-year follow-up. A total of 44 patients (66% men; median [range] age, 61 [28-78] years) were included. All participants had a complete echocardiographic evaluation at baseline and at 1-year follow-up.

Results: Left ventricular (LV) systolic function, LV mass, left atrial volumes, and blood pressure response did not differ between groups during 1-year follow-up. There was, however, a difference between the groups in change in peak early mitral velocity after 1 year (P=0.02), and E/e' ratio trended higher in the everolimus group (P=0.09).

Conclusions: Early conversion from CsA-based to everolimus-based immunosuppressive treatment in de novo renal transplant recipients caused marginal changes in LV diastolic function but no effect on LV systolic function or LV mass.