Impact of early conversion from cyclosporin to everolimus on left ventricular mass index: a randomized controlled trial

Anoushka Krishnan, Armando Teixeira-Pinto, Doris Chan, Aron Chakera, Gusharan Dogra, Neil Boudville, Ashley Irish, Kelly Morgan, Jessica Phillips, Germaine Wong, Wai H Lim

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    Abstract

    This is an 18-month prospective, randomized controlled trial (RCT) designed to compare the effect of early conversion from cyclosporin to everolimus/ mycophenolic acid (E-MPA) between 3-4 months post-transplant to cyclosporin/mycophenolic acid (CsA-MPA) on left ventricular mass index (LVMI) at 3 and 18 months post-transplant (primary outcome). Secondary outcomes included estimated glomerular filtration rate (eGFR), viral infection and adverse events. Twenty-four patients were randomized in a 1:1 ratio to E-MPA or CsA-MPA groups. There were no significant differences in mean (SD) LVMI at 3 (51.6±18.5 vs. 53.7±15.7g/m2.7 ) and 18 months (52.7±16.3 vs. 51.7±16.8g/m2.7 ) between CsA-MPA and E-MPA groups. The incidence of viral infections was reduced in E-MPA compared to CsA-MPA treatment groups (8% vs. 50%, p=0.02), but the incidences of acute rejection, adverse events and drug discontinuation were similar between groups. There was an overall increase in eGFR with time (0.04 log- ml/min/1.73m2 per 6 months, p=0.012) but no significant difference between the two groups across time (0.11 log- ml/min/1.73m2 , p=0.311). Immunosuppressive regimen comprising of early conversion from cyclosporine to everolimus was not associated with a regression of LVMI, but a lower risk of viral infections was observed. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000320055).
    Original languageEnglish
    Article numbere13043
    Number of pages9
    JournalClinical Transplantation
    Volume31
    Issue number10
    Early online date29 Jun 2017
    DOIs
    Publication statusPublished - Oct 2017

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