LVH Reversible After Transplantation

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ACE inhibitor decreased left ventricular hypertrophy that persisted following renal transplantation.

 

Prolonged ACE inhibitor treatment can reverse left ventricular hypertrophy (LVH) in renal transplant recipients receiving cyclosporine-based immunosuppression, according to researchers.

 

The mechanism by which this regression occurs is independent of an ACE inhibitor's effect on BP.

 

Ernesto Paoletti, MD, of the division of nephrology, dialysis, and transplantation, Ospedale S. Martino, Genova, Italy, and his colleagues studied 70 renal transplant recipients aged 30-68 years who did not have diabetes. The patients had been randomly assigned to receive either cyclosporine or tacrolimus therapy and had LVH persisting for three to six months after transplantation.

 

Random assignments were made for 36 patients to receive the ACE inhibitor lisinopril and 34 patients to receive no therapy. Patients in both study arms had similar baseline echocardiographic data, including left ventricular mass (LVM) index.

 

After 18 months, the LVM index decreased significantly by 9.1 g/m2.7 in the ACE inhibitor group and in-creased nonsignificantly by 1 g/m2.7 in the control arm, for a between-group difference of 10.1 g/m2.7, the authors reported in the American Journal of Kidney Diseases (2007;50:133-142).

 

The decrease in LVM index was restricted to patients on cyclosporine-based immunosuppressive regimens; tacrolimus recipients experienced no such decrease. The authors said they had no explanation for the discrepancy.

 

At baseline, BP was almost adequately controlled in all subjects. At 18 months, both study arms had similar and significant decreases in both systolic and diastolic BP, “potentially accounting for the lack of LVH worsening we observed,” the authors noted.

 

They also observed no relationship between degree of BP decrease and magnitude of change in LVM index.

 

Based on their findings, Dr. Paoletti and his colleagues said they recommend that ACE inhibitor therapy be adopted early in post-transplant management, at least for patients with proven LVH who are undergoing cyclosporine-based immunosuppressive therapy.

 

In previous studies of LVH in renal transplant patients, treatments were started immediately after transplantation, “when LVH is the result of previous ESRD,” the investigators said. No data are available regarding the long-term effect of ACE inhibitors on LVH that persists after transplantation. The researchers acknowledged limitations of their study, such as small sample size and the fact that it was conducted at a single center.

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