Key result
Everolimus-based immunosuppression in pediatric kidney transplant recipients was associated with a twofold more reduced skin micro-vascular function compared to standard treatment (p<0.001).
Why the study?
Does everolimus-based immunosuppression compared to standard treatment affect micro- and macro-vascular status in pediatric kidney transplant recipients?
Cross-Sectional (n=44)
Does everolimus-based immunosuppression compared to standard treatment affect micro- and macro-vascular status in pediatric kidney transplant recipients?
p-value: p=< 0.001
Everolimus-based immunosuppression in pediatric kidney transplant recipients is associated with more pronounced endothelial dysfunction compared to standard mycophenolate-based regimens.
Does not support changing regimens now; leaves open clinical relevance of everolimus-associated microvascular impairment and needs prospective studies.
BACKGROUND/AIMS: Whether the immunosuppressive regimen is associated with micro- and macro-vascular status in pediatric kidney transplant recipients (KTx) is unknown. METHODS: We performed a cross-sectional, case-control study in 44 pediatric KTx patients on either everolimus (EVR) plus calcineurin inhibitor or standard treatment, i.e. mycophenolate mofetil plus calcineurin inhibitor. Measurement of carotid intima-media thickness (cIMT) via ultrasound, central pulse wave velocity (PWV) by a cuff-based oscillometric technique, and skin microvascular blood flow during local heating via laser-Doppler-fluximetry (LDF) served as marker of subclinical vascular disease. Serum concentrations of angiopoietin-1 and -2, fibroblast-growth factor 23 (FGF23) and soluble klotho were measured. RESULTS: EVR-treated patients exhibited a similar degree of hypertension, increased cIMT, elevated pro-inflammatory angiopoietin-2, and diminished endothelial survival factor angiopoietin-1 compared to healthy children but presented with a twofold more reduced skin micro-vascular function compared to standard treatment (each p< 0.001). By contrast, PWV and soluble klotho levels were normal in both groups. CONCLUSION: Endothelial dysfunction seems more frequent in KTx patients on EVR-based immunosuppressive regimen compared to standard immunosuppression.
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Ruben et al. (2018) conducted a cross-sectional in Pediatric kidney transplant recipients (n=44). Everolimus plus calcineurin inhibitor vs. Mycophenolate mofetil plus calcineurin inhibitor was evaluated on Skin micro-vascular function (p=< 0.001). Everolimus-based immunosuppression in pediatric kidney transplant recipients was associated with a twofold more reduced skin micro-vascular function compared to standard treatment (p<0.001).
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