Allograft Vasculopathy in Transplanted Hearts and the Role of FGF 23-Klotho Axis

Background: There are increasing evidences in the role of the involvement of the fibroblast growth factor 23 (FGF 23) - clotho axis in the pathogenesis of endothelial disfunction and cardiovascular disease. This study intended to explore the role of FGF 23 - clotho axis in the development of allograft vasculopathy. Methods: A total of 38 biatrial heart transplant patients who were operated were included in the study (20 males, 11 females; mean age: 44 ± 7 years). CFR was measured in all patients and the patients were divided into two groups according to respective CFR values. CFR > 2 patients constituted CAV (-) group, CFR < 2 patients were enrolled into CAV (+) group. FGF 23 and clotho levels were analyzed and compared in both groups. Results: FGF 23 levels were significantly higher in CAV (+) group (264.0±114.4 vs. 183.5±56.0 p=0.04). There was a good but inverse correlation between CFR and FGF 23 levels in CAV (+) group (r= - 0.71 p=0.03). Clotho levels were significantly lower in patients who have CAV (2.76±1.6 vs. 4.77±0.87 p=0.01). There was a moderate correlation between CFR and clotho levels in CAV (+) group (r=0.62 p=0.04). There was an inverse correlation between clotho and FGF 23 levels in both CAV (+) and CAV (-) groups. Conclusion: In transplanted patients, there was a good but negative correlation between CFR and FGF 23 levels. Conversely, there was a good correlation between CFR and clotho levels. These results gave rise to the thought clotho-FGF 23 axis has a role in the development of CAV.