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© Research
Publication : Transplant international : official journal of the European Society for Organ Transplantation

Progression of pulse pressure in kidney recipients durably exposed to CsA is a risk factor for epithelial phenotypic changes: an ancillary study of the CONCEPT trial

Scientific Fields
Diseases
Organisms
Applications
Technique

Published in Transplant international : official journal of the European Society for Organ Transplantation - 28 Jan 2014

Xu-Dubois YC, Hertig A, Lebranchu Y, Hurault de Ligny B, Thervet E, Jauréguy M, Touchard G, Le Pogamp P, Le Meur Y, Toupance O, Heng AE, Bayle F, Girardot-Seguin S, Servais A, Meas-Yedid V, Rondeau E

Link to Pubmed [PMID] – 24279707

Transpl. Int. 2014 Apr;27(4):344-52

In this ancillary study of the CONCEPT trial, we studied the role of CsA withdrawal at 3 months (3M) post-transplant on the intensity of epithelial phenotypic changes (EPC, an early marker for kidney fibrogenesis) on the 12 M surveillance biopsy. Although conversion from CsA to sirolimus (SRL) at 3M was reported to have improved mean graft function at 12 M, it did not reduce the score of EPC (1.73 ± 1.15 in the SRL group vs. 1.87 ± 1 in the CsA group, P = 0.61). Acute rejection, which had occurred twice more frequently in SRL-converted patients included here, was associated with 12 M EPC. Interestingly, we observed that the patients durably exposed to CsA and who developed 12 M EPC had a significant progression of blood pulse pressure (pp) from 1 to 6M post-transplantation (Δpp = +12.3 mmHg, P = 0.0035). Pulse pressure at 4, 6, and 9 M and pp progression from 1 to 6M were significantly associated with the development of EPC at 12 M in renal grafts. Logistic regression analysis revealed that a high 6M pp (≥ 60 mmHg) was an independent risk factor for 12 M EPC with an odds ratio of 2.25 per additional 10 mmHg pp (95%CI: 1.14-4.4, P = 0.02) after adjustment with recipient’s and donor’s age, acute rejection incidence and immunosuppressive regimen. A post hoc analysis of the data collected in the whole population CONCEPT study revealed that pp was significantly higher at 6 months in patients maintained on CsA and that at this time point pp correlated negatively with GFR at 1 year.

https://www.ncbi.nlm.nih.gov/pubmed/24279707