Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Transpl Int. 2018 Dec;31(12):1380-1390. doi: 10.1111/tri.13322. Epub 2018 Aug 28.
Long-term data on cardiovascular (CV) outcome of renal transplant recipients (RTR) on mTOR-i (mammalian Target Of Rapamycin-inhibitors) are scarce. In a sub-study of the MECANO trial we investigated changes in intima media thickness (IMT), CV risk profile, Major Adverse CV Events (MACE) and survival in RTR on a mTORi versus CNI based regimen. Patients (enrolled 361) were treated with (basiliximab) and triple IS (CsA-Cyclosporine A-(C), MPS (M), prednisolone (P)). At M6 patients were randomized (n = 224) to the CsA group (C, P, N = 89), MPS group (M, P, N = 39) EVL group (Everolimus, P, N = 96). At week 2, M6 and M 24, IMT measurements of the Common Carotid Artery were performed. Cardiovascular risk factors were assessed at baseline, 6 and 24 months of follow-up. Seven years survival and MACE-free survival probability were calculated by the Cardiovascular Risk Calculator for RTR. After 7 years of follow-up, incidence of cardiovascular events and patient survival were assessed. Mean IMT at baseline (N = 192), was 0.64 ± 0.14 mm. At M6 (N = 158), 0.66 ± 0.15, M24 IMT was 0.68 ± 0.15 (N = 95). No significant differences between groups concerning IMT, true CV events and mortality, CV risk profile, predicted MACE/Mortality were found between mTORi and CNI-based regimen after 7 years of follow-up.
关于接受 mTOR-i（雷帕霉素靶蛋白抑制剂）治疗的肾移植受者（RTR）心血管（CV）结局的长期数据很少。在 MECANO 试验的一项子研究中，我们研究了在 mTORi 与基于 CNI 的方案中，RTR 的内膜中层厚度（IMT）变化、CV 风险状况、主要不良 CV 事件（MACE）和存活率。患者（入组 361 例）接受（巴利昔单抗）和三联免疫抑制方案（环孢素 A（CsA）-环孢素 A-(C)、霉酚酸酯（MPS）、泼尼松龙（P））治疗。在 M6 时，患者（n = 224）随机分为 CsA 组（C、P、N = 89）、MPS 组（M、P、N = 39）和 EVL 组（依维莫司，P，N = 96）。在第 2 周和 M6 时，进行颈总动脉 IMT 测量。在基线、6 个月和 24 个月的随访时评估心血管危险因素。使用 RTR 心血管风险计算器计算 7 年生存率和 MACE 无事件生存率。在 7 年随访后，评估心血管事件发生率和患者生存率。基线时（N = 192）的平均 IMT 为 0.64 ± 0.14 mm。在 M6 时（N = 158），0.66 ± 0.15，M24 IMT 为 0.68 ± 0.15（N = 95）。在 7 年随访后，mTORi 和基于 CNI 的方案之间在 IMT、真实 CV 事件和死亡率、CV 风险状况、预测的 MACE/死亡率方面未发现显著差异。
