Comparison of the effects of sirolimus and cyclosporine on left ventricular hypertrophy in kidney transplant recipients, A 1-year single center prospective cohort study in Dr. Shariati hospital Tehran, Iran

Introduction. Left Ventricular Hypertrophy (LVH) is an independent risk factor for death and cardiovascular disease in kidney transplant recipients. Here, we compared the effects of Cyclosporine and Sirolimus (SRL) on LV Mass Index (LVMI) one year after renal transplantation. Methods. Fifty-five end-stage renal disease patients who had LVH without diabetes and hypertension and received single-kidney transplant from living unrelated donor during year 2009 to 2010 were selected. Patients were randomly divided into either SRL group (n=19) or control (received Cyclosporine, n=36). Patients' blood pressure (BP) was checked twice per month and conventional antihypertensive therapy was used to keep BP on ≤ 130/80 mmHg. Left Ventricular Mass (LVM), LVMI, Left Ventricular End Diastolic Dimension (LVEDD), Inter Ventricular Septal Dimension (IVSD), and Posterior Wall Dimension (PWD) was measured by echocardiography at baseline and 1 year after transplantation. Results. Two groups were matched based on age and gender (male 63.16% in SRL vs 58.3% in control). We detected a significant regression of LVH in patients on SRL compared to control group (P < .0001). In contrast to control group, significant decrease in LVMI (137.59 versus 108.08 g/m2; P < .0001), IVSD (12.86 versus 10.79 mm, P < .0001) and PWD (13.03 versus 10.98 mm, P < .0001), compared to base line was observed in SRL group. Changes in other variables including LVEDD and BP in two groups were not significant. Conclusions. SRL therapy may cause regression in LVH in renal transplant recipients, mainly by decreasing LV wall thickness, without affecting the LVEDD and BP. Effect of SRL on LVM most probably does not have a hemodynamic origin. Future multi-center studies with larger sample size are recommended to establish the effectiveness of SRL for better cardiovascular outcomes in renal transplant recipients.