Date: Tuesday, May 5, 2015
Session Name: Concurrent Session: Kidney: Cardiovascular and Metabolic
Session Time: 2:15pm-3:45pm
Presentation Time: 3:03pm-3:15pm
Location: Terrace I-III
Background: Left ventricular hypertrophy (LVH) is common in kidney transplant recipients (KTxR) and has shown to be a risk factor for death and heart failure after KTx. An early switch from a CNI to everolimus (EVR)-based regimen may prevent the post-KTx CVD risk. ELEVATE study (NCT01114529) evaluated the effect of EVR on LVH in de novo KTxR vs standard CNI. Methods: In this 24-month (M), multicenter, open-label study, de novo KTxR were randomized (RND) after 10-14 weeks to EVR (C0 610ng/mL) or continued standard CNI (C0, tacrolimus: 510ng/mL, cyclosporine: 100250ng/mL). All patients received enteric-coated mycophenolate sodium and steroids. Left ventricular mass (LVM) was assessed at RND and M12 using echocardiography (ECG). LVM index (LVMi) was calculated using LVM and indexed by height2.7. LVH was considered if LVMi >49.2g/m2.7 for male and >46.7g/m2.7 for female. In addition, sensitivity analysis utilizing BSA indexation was performed. Patients with data for ECG variables at both RND and M12 visits were included in the analyses. Results: Overall, 527 patients (EVR, 245 and CNI, 282) were included in the analysis. LVH at RND was detected in 133 EVR (36.8% concentric, 63.2% eccentric) and 151 CNI patients (44.4% concentric, 55.6% eccentric). LVH at M12 was observed in 126 EVR (38.1% concentric, 61.9% eccentric) and 137 CNI patients (48.9% concentric, 51.1% eccentric). At M12, LS mean difference for LVMi in LVH patients was -5.74g/m2.7 and -4.25g/m2.7 for EVR vs CNI respectively with a difference not statistically significant (LS Mean 5.94g/m2.7 [95%CI -1.35, 13.23]; p=0.11). Additionally, change in LVMi for concentric LVH was -5.71g/m2.7 and -4.25g/m2.7 (mean difference: -1.49g/m2.7; p=0.58) for EVR and CNI, respectively. The change in LVMi for eccentric LVH was 5.10g/m2.7 and -4.48g/m2.7 (mean difference: 9.58 g/m2.7, p=0.10) for EVR and CNI, respectively. Fewer patients in EVR vs CNI arm had increased concentric LVH (+1.3% vs +4.5%) and a reduction in eccentric LVH (-1.3% vs -4.5%). Sensitivity analysis performed by utilizing BSA indexation provided similar results. Conclusion: After only 9M post-CNI conversion, 12M analysis showed a differential effect of the two treatments on LVMi, being more favorable for EVR on patients with concentric LVH and for CNI on patients with eccentric LVH.
To cite this abstract in AMA style:Giet Mvander, Holdaas H, Fijter Jde, Speziale A, Escrig C, Junge G, Wang Z, Cruzado J. Effect of Everolimus on Left Ventricular Hypertrophy in De Novo Kidney Transplant Recipients: 12-Month Results from the ELEVATE Study [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/effect-of-everolimus-on-left-ventricular-hypertrophy-in-de-novo-kidney-transplant-recipients-12-month-results-from-the-elevate-study/. Accessed February 22, 2020.
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