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

• Published in: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia Vol. 35; no. 1; p. 58
• Main Authors: Melilli, Edoardo, Bestard-Matamoros, Oriol, Manonelles-Montero, Anna, Sala-Bassa, Neus, Mast, Richard, Grinyó-Boira, Josep M, Cruzado, Josep M
• Format: Journal Article
• Language: English
• Published: Spain 2015
• Subjects: 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
• ISSN: 1989-2284
• DOI: 10.3265/Nefrologia.pre2014.Sep.12615

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.