Long-term cardiovascular outcome of renal transplant recipients after early conversion to everolimus compared to calcineurin inhibition: results from the randomized controlled MECANO trial

Long-term data on cardiovascular (CV) outcome of renal transplant recipients (RTR) on mTOR-i (mammalian Target Of Rapamycin-inhibitors) are scarce. In a sub-study of the MECANO trial we investigated changes in intima media thickness (IMT), CV risk profile, Major Adverse CV Events (MACE) and survival in RTR on a mTORi versus CNI based regimen. Patients (enrolled 361) were treated with (basiliximab) and triple IS (CsA-Cyclosporine A-(C), MPS(M), prednisolone(P)). At M6 patients were randomized (n=224) to the CsA group (C, P, N=89), MPS group (M, P, N=39) EVL group (Everolimus, P, N=96). At week 2, M6 and M 24, IMT measurements of the Common Carotid Artery were performed. Cardiovascular risk factors were assessed at baseline, 6 and 24 months of follow-up. Seven years survival and MACE -free survival probability were calculated by the Cardiovascular Risk Calculator for RTR. After seven years of follow-up incidence of cardiovascular events and patient survival were assessed. Mean IMT at baseline, (N=192), was 0.64±0.14 mm. At M6 (N=158), 0.66±0.15, M24 IMT was 0.68±0.15 (N=95).

CONCLUSION: No significant differences between groups concerning IMT, true CV events and mortality, CV risk profile, predicted MACE / Mortality were found between mTORi and CNI-based regimen after 7 years of follow-up. This article is protected by copyright. All rights reserved.