Morphological and functional changes in the heart are associated with a high degree of morbidity and mortality after a kidney transplant. Anti-mTOR drugs may revert these changes. We studied prospectively 25 nondiabetic kidney transplant recipients (aged 59±13 years; 15 men and 10 women) who were converted from a calcineurin inhibitor to an anti-mTOR drug (11 everolimus, 14 sirolimus) due to skin cancer or chronic graft dysfunction. The median follow-up was 80 months (interquartile range 2-268 months). Echocardiography (M mode, 2D and Doppler flow) was performed at the time of conversion and one year later. After the conversion there was a significant reduction in left ventricular mass index (LVMI, 158.3±60 vs. 146.3±56 g/m², P=0.02), adjusting for the post-transplant time, and 20% of the patients showed a LVMI regression >20%. Whereas 72% of the patients (18/25) had criteria for left ventricular hypertrophy at the start of the study, this was present in 60% (15/25) at the end of the follow-up. This was seen in the absence of any changes in the systolic (126±12 versus 127±15 mmHg) or diastolic (73±9 versus 74±8 mmHg) blood pressure. A similar proportion of patients experienced diastolic dysfunction (E wave/A wave <1) before and after the conversion (70% versus 63%). The cardiac isovolumetric relaxation time (IVRT) experienced a significant increase at the end of the follow-up as compared with the baseline study (98±18 versus 114±25 ms; P=0.049). Though no patient developed systolic dysfunction, the ejection fraction fell significantly at the end of the study (67.5±5% versus 64±5%; P=0.048) and there was an inverse correlation between the IVRT and the ejection fraction (r=-0.429; P=0.032). In summary, conversion from a calcineurin inhibitor to an anti-mTOR drug may contribute to changes in cardiac remodeling and distensibility, independently of the blood pressure and the post-transplant time.

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