A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Left Atrial Structural and Functional Response in Kidney Transplant Recipients Treated With Mesenchymal Stromal Cell Therapy and Early Tacrolimus Withdrawal
Tekijät: Meucci Maria Chiara, Reinders Marlies EJ, Groeneweg Koen E, Bezstarosti Suzanne, Marsan Nina Ajmone, Bax Jeroen J, De Fijter Johan W, Delgado Victoria
Kustantaja: Elsevier Inc.
Julkaisuvuosi: 2022
Journal: Journal of The American Society of Echocardiography
Tietokannassa oleva lehden nimi: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
Lehden akronyymi: J Am Soc Echocardiogr
ISSN: 0894-7317
eISSN: 1097-6795
DOI: https://doi.org/10.1016/j.echo.2022.10.022
Verkko-osoite: https://doi.org/10.1016/j.echo.2022.10.022
BACKGROUND
Autologous bone marrow-derived mesenchymal stromal cell (MSC) therapy and withdrawal of calcineurin inhibitors (CNIs) has been shown to improve systemic blood pressure control and left ventricular hypertrophy regression in kidney transplant recipients. In the current subanalysis, we aimed to evaluate the impact of this novel immunosuppressive regimen on the longitudinal changes of left atrial (LA) structure and function after kidney transplantation.
METHODS
Kidney transplant recipients randomized to MSC therapy-infused at weeks 6 and 7 after transplantation, with complete discontinuation at week 8 of tacrolimus (MSC group)-or standard tacrolimus dose (control group) were evaluated with transthoracic echocardiography at weeks 4 and 24 after kidney transplantation. The changes in echocardiographic parameters were compared between the randomization arms using an analysis of covariance model adjusted for baseline variable.
RESULTS
Fifty-four participants (MSC therapy = 27; tacrolimus therapy = 27) were included. There was no significant interaction between the allocated treatment and the changes of indexed maximal LA volume (LAVImax) over the study period. Conversely, between 4 and 24 weeks post-transplantation, an increase in indexed minimal LA volume (LAVImin) was observed in control subjects, while it remained unchanged in the MSC group, leading to a significant difference between groups (P = .021). Additionally, patients treated with MSC therapy showed a benefit in LA function, assessed by a significant interaction between changes in LA emptying fraction and LA reservoir strain and the randomization arm (P = .012 and P = .027, respectively).
CONCLUSIONS
The combination of MSC therapy and CNIs withdrawal prevents progressive LA dilation and dysfunction in the first 6 months after kidney transplantation. LAVImin and LA reservoir strain may be more sensitive markers of LA reverse remodeling, compared with LAVImax.