Metabolic and Renal Effects of Mammalian Target of Rapamycin Inhibitors Treatment After Liver Transplantation: Real-Life Single-Center Experience.
Aged
Calcineurin Inhibitors
/ adverse effects
Cohort Studies
Everolimus
/ therapeutic use
Female
Humans
Immunosuppressive Agents
/ therapeutic use
Kidney
/ drug effects
Kidney Diseases
/ epidemiology
Liver Transplantation
/ adverse effects
Male
Metabolic Syndrome
/ epidemiology
Middle Aged
Postoperative Complications
/ epidemiology
Retrospective Studies
Sirolimus
/ therapeutic use
Journal
Transplantation proceedings
ISSN: 1873-2623
Titre abrégé: Transplant Proc
Pays: United States
ID NLM: 0243532
Informations de publication
Date de publication:
Historique:
received:
20
01
2020
accepted:
12
05
2020
pubmed:
12
7
2020
medline:
20
4
2021
entrez:
12
7
2020
Statut:
ppublish
Résumé
Mammalian target of rapamycin (mTOR) inhibitors following liver transplantation (LT) are used to minimize calcineurin inhibitor (CNI)-related nephrotoxicity. Data about metabolic effects of mTOR inhibitors are still limited. This study aims to determine the renal and metabolic effects of different mTOR inhibitor-based protocols in real-life LT patients. This is a retrospective cohort study of patients treated with mTOR inhibitors after LT. Demographics, treatment protocols, glomerular filtration rate (GFR), and metabolic parameters were collected over a period of 4 years. Initiation of blood pressure (BP), diabetes mellitus, and lipid medications was also noted. Fifty-two LT recipients received mTOR inhibitors. GFR improved significantly (by 1.96 mL/min/year), with greater improvement in patients with baseline renal dysfunction (+13.3 mL/min vs +4.5 mL/min at 3 years). Conversion to an mTOR inhibitor during the first post-transplant year resulted in a more durable improvement in GFR (for 4 years vs only 1 year for later conversion).No significant weight gain or new-onset diabetes mellitus was observed. However, there was some increase in total cholesterol (+7 mg/dL) and blood pressure (+2 mm Hg during the third year and +8 mm Hg in the fourth years), followed by initiation of lipid-lowering and BP medications in 25% and 13% of patients, respectively. Treatment with an mTOR inhibitor following LT resulted in improved kidney functions without significant negative metabolic effects such as weight gain or new-onset diabetes mellitus. This makes mTOR inhibitors a valuable immunosuppressive option in the face of the growing incidence of nonalcoholic steatohepatitis as a leading cause for LT.
Sections du résumé
BACKGROUND
BACKGROUND
Mammalian target of rapamycin (mTOR) inhibitors following liver transplantation (LT) are used to minimize calcineurin inhibitor (CNI)-related nephrotoxicity. Data about metabolic effects of mTOR inhibitors are still limited.
AIM
OBJECTIVE
This study aims to determine the renal and metabolic effects of different mTOR inhibitor-based protocols in real-life LT patients.
METHODS
METHODS
This is a retrospective cohort study of patients treated with mTOR inhibitors after LT. Demographics, treatment protocols, glomerular filtration rate (GFR), and metabolic parameters were collected over a period of 4 years. Initiation of blood pressure (BP), diabetes mellitus, and lipid medications was also noted.
RESULTS
RESULTS
Fifty-two LT recipients received mTOR inhibitors. GFR improved significantly (by 1.96 mL/min/year), with greater improvement in patients with baseline renal dysfunction (+13.3 mL/min vs +4.5 mL/min at 3 years). Conversion to an mTOR inhibitor during the first post-transplant year resulted in a more durable improvement in GFR (for 4 years vs only 1 year for later conversion).No significant weight gain or new-onset diabetes mellitus was observed. However, there was some increase in total cholesterol (+7 mg/dL) and blood pressure (+2 mm Hg during the third year and +8 mm Hg in the fourth years), followed by initiation of lipid-lowering and BP medications in 25% and 13% of patients, respectively.
CONCLUSIONS
CONCLUSIONS
Treatment with an mTOR inhibitor following LT resulted in improved kidney functions without significant negative metabolic effects such as weight gain or new-onset diabetes mellitus. This makes mTOR inhibitors a valuable immunosuppressive option in the face of the growing incidence of nonalcoholic steatohepatitis as a leading cause for LT.
Identifiants
pubmed: 32650991
pii: S0041-1345(20)30174-3
doi: 10.1016/j.transproceed.2020.05.021
pii:
doi:
Substances chimiques
Calcineurin Inhibitors
0
Immunosuppressive Agents
0
Everolimus
9HW64Q8G6G
Sirolimus
W36ZG6FT64
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
221-227Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.