Effects of mTOR inhibitor–related proteinuria on progression of cardiac allograft vasculopathy and outcomes among heart transplant recipients

Rabea Asleh, Hilmi Alnsasra, Amir Lerman, Alexandros Briasoulis, Naveen L. Pereira, Brooks S. Edwards, Takumi Toya, John M. Stulak, Alfredo L. Clavell, Richard C Daly, Sudhir Kushwaha

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

We have previously described the use of sirolimus (SRL) as primary immunosuppression following heart transplantation (HT). The advantages of this approach include attenuation of cardiac allograft vasculopathy (CAV), improvement in glomerular filtration rate (GFR), and reduced malignancy. However, in some patients SRL may cause significant proteinuria. We sought to investigate the prognostic value of proteinuria after conversion to SRL. CAV progression and adverse clinical events were studied. CAV progression was assessed by measuring the Δ change in plaque volume (PV) and plaque index (PI) per year using coronary intravascular ultrasound. Proteinuria was defined as Δ urine protein ≥300 mg/24 h at 1 year after conversion to SRL. Overall, 137 patients were analyzed (26% with proteinuria). Patients with proteinuria had significantly lower GFR (P =.005) but similar GFR during follow-up. Delta PV (P <.001) and Δ PI (P =.001) were significantly higher among patients with proteinuria after adjustment for baseline characteristics. Multivariate Cox regression analysis showed higher all-cause mortality (hazard ratio 3.8; P =.01) with proteinuria but similar risk of CAV-related events (P =.61). Our results indicate that proteinuria is a marker of baseline renal dysfunction, and that HT recipients who develop proteinuria after conversion to SRL have less attenuation of CAV progression and higher mortality risk.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - 2020

Keywords

  • clinical research/practice
  • coronary artery disease
  • glomerular filtration rate (GFR)
  • heart transplantation/cardiology
  • immunosuppressant
  • immunosuppression/immune modulation
  • vasculopathy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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