Impact of late calcineurin inhibitor withdrawal on ambulatory blood pressure and carotid Intima media thickness in renal transplant recipients.
Mourer JS, de Koning EJ, et al.Transplantation 2013; 96(1):49-57
Aims
To investigate the impact of calcineurin inhibitor (CNI) or mycophenolate mofetil withdrawal (MMF) on ambulatory blood pressure and carotid intima media thickness (IMT).
Interventions
Patients were randomized to receive either concentration controlled withdrawal of CNI or MMF.
Participants
119 stable renal transplant recipients.
Outcomes
The outcomes of the study included the change in ambulatory blood pressure and carotid IMT.
Follow-up
3 years.
CET Conclusions
In this study from the Netherlands patients on triple therapy comprising a CNI, MMF and steroids were randomised to have a gradual withdrawal of a CNI or MMF over a four week period. Ambulatory blood pressure monitoring was performed over a 3 year follow up period and both systolic and diastolic blood pressure were significantly reduced but interestingly there was no difference in carotid intima media thickness over this period in the patients in whom the CNI was withdrawn. Thus this does provide another argument in favour of withdrawing CNI where that is possible
Data analysis
Modified intention-to-treat analysis
Quality notes
Previously assessed Mourer et al. Randomized trial comparing late concentration controlled calcineurin inhibitor or mycophenolate mofetil withdrawal. Transplantation 2010; 93: 887.
Trial registration
NCT00169910