Arterial stiffness in kidney transplantation: a single center case-control study comparing belatacept versus calcineurin inhibitor immunosuppressive based regimen

Nefrologia. 2015;35(1):58-65. doi: 10.3265/Nefrologia.pre2014.Sep.12615.
[Article in English, Spanish]

Abstract

Arterial stiffness is nowadays a well-accepted predictor of cardiovascular mortality in general population; as well as in kidney transplant recipient population. The femoral-carotid pulse wave velocity (cf-PWV) is the widest used method to assess the arterial stiffness. The aim of this study was to test whether CNI-free immunosuppression based on belatacept was associated with lower cf-PWV, as a surrogate marker of arterial stiffness, than CNI. This was a retrospective case-control study. We included all the cases treated with belatacept as a maintenance immunosuppression in our center (n=20). An appropriate control group of patients (n=20) treated with CNI was selected to achieve match for key factors associated with arterial stiffness. After a follow-up of 5 years after transplantation, the Belatacept group had a reduced prevalence of patients with a cf-PWV higher than 8.1m/s (50% in BLC vs. 25% in CNI, p=0.08). At multivariate logistic regression analysis, the risk of high cf-PWV was correlated with age (OR 1.24; p<0.03) and renal resistive index (OR 1.25; p<0.05). Belatacept treatment was associated with a significant reduction in risk of cf-PWV (OR 0.008; P=0.045). Belatacept-based maintenance immunosuppression could improve kidney transplant recipient’s survival by reducing cardiovascular events related to stiffness.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abatacept / pharmacology*
  • Abatacept / therapeutic use
  • Adult
  • Aged
  • Aorta / drug effects
  • Calcineurin Inhibitors / pharmacology*
  • Calcineurin Inhibitors / therapeutic use
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Graft vs Host Disease / drug therapy
  • Humans
  • Immunosuppressive Agents / pharmacology*
  • Immunosuppressive Agents / therapeutic use
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Pulse Wave Analysis
  • Risk Factors
  • Vascular Stiffness / drug effects*

Substances

  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Abatacept