Comparative effects of sirolimus and cyclosporin on conduit arteries endothelial function in kidney recipients

P>This study attempted to establish whether a calcineurin inhibitor (CNI)-free immunosuppressant regimen based on sirolimus (SRL) is associated with a preservation of conduit arteries endothelial function in kidney recipients or not. Twenty-nine kidney recipients were randomized to receive since transplantation SRL (n = 15) or cyclosporin A (CsA, n = 14) associated with mycophenolate mofetil (MMF) and steroids (6 months) in a parallel prospective study. Systolic, diastolic blood pressures, glomerular filtration rate (GFR) and radial artery flow-mediated dilatation (FMD) induced by postischaemic hyperaemia were assessed in a blind manner at one (M1) and 7 months (M7) after transplantation. Endothelium-independent dilatation was assessed by glyceryl trinitrate spray. There was no difference between the groups for all vascular parameters at M1. At M7, systolic blood pressure was lower (SRL: 119 +/- 3 vs. CsA: 138 +/- 4 mmHg, P < 0.05) and FMD was higher in SRL compared with CsA (SRL: 13.1 +/- 0.9 vs. CsA: 9.9 +/- 0.9%, P < 0.05) without any difference for hyperaemia, endothelium-independent dilatation and GFR (SRL: 66.7 +/- 1.05 vs. CsA: 67.5 +/- 1.22 ml/min). Our results demonstrate that a CNI-free regimen based on SRL and MMF prevents conduit artery endothelial dysfunction compared with CsA and MMF in kidney recipients suggesting a beneficial arterial wall effect that may also contribute to the decrease in systolic blood pressure.