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Abstract: FR-PO854

Is It Calcineurin Inhibition That Abolishes Cardiovascular Sex Differences in Kidney Transplant Patients?

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Author

  • Ural, Zeynep, Gazi Universitesi Tip Fakultesi, Ankara, Ankara, Turkey
Background

Cardiovascular disease (CVD) is the leading cause of death after renal transplantation. Cardiac hypertrophy is a stronger risk factor for heart failure. Estrogen protecs heart by counteracting pro-hypertrophy signaling pathways. Wheras androgen mostly plays an opposite role in cardiac hypertrophy. Cardiac hypertrophy is characterized by abnormality of intracellüler calcium homeostasis and calcium related activation of major hypertrophic signaling pathway (calcineurin-nuclear factor activation transcription pathway). Estrogen inhibits calcineurin expression. In this study we aimed to explore sex difference in cardiac hypertrophy and sex spesific cardiac hypertrophy rates in renal transplant patients under CNI ( Calcineurin inhibitors) or mTORi ( mammalian target of rapamycin inhibitors) based regimes.

Methods

This study consist of one hundred and fifty two (152) renal allogreft recipients with less than one year of dialysis and who are at least three years of follow-up.The exclusion criterias were, dialysis for more than one year before transplant, pre-transplant cardiac hypertrophia. Echocardiograms of the patients at the third year after transplantation were evaluated. Ejection fraction rate, left atrial diameter, presence of left ventricular hypertrophy were evaluated.

Results

Baseline characteristics and helath parameters were similar between CNI and mTORi based regimes. Ejection fraction, left atrial diameter, left ventricular hypertrophy were evaluated. There is important difference between man and women for echocardiography findings. Morever, cardiac hypertrophy findings were significantly less observed in those using the CNI regimen (%5,7 to %29). In addition, cardiac hypertrophy was more common in males using mTORi regimen (Male/female; %35/%18), while there was no difference males and females using CNI regimen (Male/female; %6/%5,2).

Conclusion

The role of the calcineurin pathway in cardiac hypertrophy has been demonstrated in many studies. Cardiac hypertrophy and heart failure, which are one of the most important causes of death in kidney transplant patients, can be prevented by calcineurin inhibition. Further prospective studies with larger numbers of patients examining this effect are needed. This effect of estrogen on the calcineurin pathway may be the solution to one of our most important problems in kidney transplant patients.

Funding

  • Private Foundation Support