engleski

LOWER MEAN ARTERIAL BLOOD PRESSURE IN RENAL TRANSPLANT PATIENTS TREATED WITH MTORI IN COMPARISON TO CNIS

Mammalian target of rapamycin inhibitors (mTORi) sirolimus and everolimus are immunosuppressive drugs which may facilitate withdrawal of calcineurin inhibitors (CNI) from the immunosuppressive protocols in patients with CNI- associated side-effects such is arterial hypertension (AH). However, AH is also one of the most frequently reported adverse effects associated with sirolimus, while everolimus has been reported to provide beneficial effects on AH. The exact effect of mTORi on AH has not been fully established yet. The aim of our study was to compare median arterial blood pressure in patients treated with mTORi or CNIs. This cross-sectional study comprised 81 kidney transplant recipients (51, 62.96% males) median age 57.50 (23-75) years with 3 (0-21) years spent on haemodialysis receiving either everolimus (n=35, 43.2%), sirolimus (n=13, 16.05%), tacrolimus (n=15, 18.52%) or cyclosporine (n=18, 22.2%). Twenty three patients (28.4%) received calcium antagonists, 45 (55.5%) furosemide, 43 (53.1%) β receptor blockers, 4 (4.9%) angiotensin converting enzyme inhibitors and 5 (6.2%) moxonidine. The highest rate of β receptor blockers use was observed in the everolimus group (n=20, 57.1%) compared to other groups with p for trend 0.036, while the use of other antihypertensive drugs showed no significant difference. Median mean arterial blood pressure derived from the formula: (2xdyastolic blood pressure+systolic blood pressure)/3, was 103(83-146) mmHg. The sirolimus group had the lowest value 96 (92-113) mmHg, following 100 (83-147) mmHg for the everolimus group, 103 (88-140) mmHg for the tacrolimus group and 109 (97-135) mmHg for the cyclosporine group with p for trend 0.018. The post hoc analysis has shown the significant difference between sirolimus and cyclosporine group (p=0.002) and everolimus and cyclosporine group (p=0.019). In the multinominal logistic regression analysis the mean arterial blood pressure value was inversely associated with sirolimus group (OR 0.906, CI 0.823-0.996, p=0.042) as well as with everolimus group (OR 0.928, CI 0.863-0.997, p=0.042) compared to cyclosporine group after adjustment for age, gender, time on haemodialysis and the use of β receptor blockers. According to our results, the use of mTORi is inversely associated with mean arterial blood pressure in compared to the use of CNIs. In order to access long-term effect of the mTORi use on AH in renal transplant recipients, further study evaluation will be required.

mTORi; CNIs; blood pressure

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