Calcineurin inhibitors' impact on cardiovascular and renal function, a descriptive study in lung transplant recipients from the North of Spain

• Published in: Scientific reports Vol. 12; no. 1; pp. 21207 - 11
• Main Authors: Nogueiras-Álvarez, Rita, Mora-Cuesta, Víctor Manuel, Cifrián-Martínez, José Manuel, de Cos-Cossío, María Ángeles, García-Sáiz, María Del Mar
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 08.12.2022; Nature Publishing Group UK; Nature Portfolio
• Subjects: Blood levels; Calcineurin; Calcineurin inhibitors; Calcineurin Inhibitors - adverse effects; Cardiovascular diseases; Cyclosporins; Diabetes mellitus; Drug development; Graft rejection; Health risks; Humans; Hyperlipidemia; Hypertension; Immunosuppression; Immunosuppressive agents; Kidney - physiology; Lung transplantation; Lung Transplantation - adverse effects; Lung transplants; Quality of Life; Renal function; Retrospective Studies; Risk factors; Statistical analysis; Tacrolimus; Toxicity; Transplantation
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-25445-2

Patients undergoing lung transplantation (LTx) need administration of immunosuppressive therapy following the procedure to prevent graft rejection. However, these drugs are not exempt from potential risks. The development of cardiovascular risk factors and impaired renal function in the post-transplantation period are conditions that may be favoured by the use of calcineurin inhibitor (CNI) drugs which could have repercussions on the quality of life and the post-transplantation evolution. To evaluate the cardiovascular and renal toxicity following the administration of CNI as maintenance immunosuppression in lung transplant recipients (LTRs) we reviewed a total number of 165 patients undergoing LTx between 01/01/2015 and 08/12/2018. They were divided into two groups according to the CNI drug administrated: cyclosporine (CsA-group) with 11 patients or tacrolimus (Tac-group), with 154 patients. We evaluated the de novo occurrence of arterial hypertension (HTN), diabetes mellitus (DM), hyperlipidemia and impaired renal function after initiation of CNI administration. In addition to that, the time until each of these events was assessed. A higher rate for developing HTN (p < 0.001) and impaired renal function (p = 0.047) was observed within the CsA-group. The new onset of hyperlipidemia was similar between both CNI groups and de novo appearance of DM was only documented in those LTRs receiving tacrolimus. In this LTRs retrospective study, it was observed that having ≥ 4 tacrolimus trough levels above the upper limit of the proposed interval for each specific post-LTx period was associated with an increased risk for developing renal impairment. No other statistically significant association was found between supratherapeutic CNIs blood levels and the evaluated toxicities.