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- Title
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.
- Authors
Xu-Dubois, Yi-Chun; Hertig, Alexandre; Lebranchu, Yvon; Hurault de Ligny, Bruno; Thervet, Eric; Jauréguy, Maïté; Touchard, Guy; Le Pogamp, Patrick; Le Meur, Yann; Toupance, Olivier; Heng, Anne-Elisabeth; Bayle, Francis; Girardot-Seguin, Sandrine; Servais, Aude; Meas-Yedid, Vannary; Rondeau, Eric
- Abstract
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 12M surveillance biopsy. Although conversion from CsA to sirolimus ( SRL) at 3M was reported to have improved mean graft function at 12M, 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 12M EPC. Interestingly, we observed that the patients durably exposed to CsA and who developed 12M 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 9M and pp progression from 1 to 6M were significantly associated with the development of EPC at 12M in renal grafts. Logistic regression analysis revealed that a high 6M pp (≥60 mmHg) was an independent risk factor for 12M 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.
- Subjects
BIOPSY; BLOOD pressure; TRANSPLANTATION immunology; KIDNEY transplantation; TRANSPLANTATION of organs, tissues, etc.; GRAFT rejection
- Publication
Transplant International, 2014, Vol 27, Issue 4, p344
- ISSN
0934-0874
- Publication type
Article
- DOI
10.1111/tri.12253