Changes in Doppler Resistance Indices After Intake of Cyclosporin a in Comparison to Tacrolimus in Patients With Stable Renal Allograft Function.

Weingart, Christian; Leingärtner, T; Bergler, Tobias; Krüger, Bernd; Mack, Matthias; Banas, Bernhard; Krämer, Bernhard K.

doi:10.1097/00007890-200407271-00896

Cited by 2 publications

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“…Amelioration of the RI after cessation of CNI appears to be a valuable indicator for reversion of renal arterial vasoconstriction in our study population of liver transplant patients, a hypothesis supported by observations made in other populations. Our data indicating reversible CNI‐mediated vasoconstriction in OLT patients are in line with a recent study demonstrating a significant RI increase in 34 renal transplant patients two h after ingestion of CNI compared with baseline, an effect reversed by nitroglycerin administration (19). Whether the individual renal RI is dependent on the time point of cyclosporine application is still a debated issue (20).…”

Section: Discussionsupporting

confidence: 92%

Relationship between renal resistance index and renal function in liver transplant recipients after cessation of calcineurin inhibitor

Eisenberger¹,

Sollinger²,

Stickel

et al. 2009

Clinical Transplantation

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End stage renal disease is a major complication after orthotopic liver transplantation (OLT). Vasoconstriction of renal arterial vessels because of calcineurin inhibitor (CNI) treatment plays a pivotal role in the development of renal insufficiency following OLT. Renal resistance can be measured non-invasively by determining the resistance index (RI) of segmental arteries by color-coded duplex ultrasonography, a measure with predictive value for future renal failure. Sixteen OLT patients on long-term CNI therapy were recruited prospectively and randomly assigned either to receive the m-TOR inhibitor sirolimus (SRL) or to continue on CNI treatment, and were followed for one yr. Serum creatinine (crea) declined after conversion to SRL, whereas it tended to increase in patients remaining on CNI (meanDelta crea SRL: -27, -18, -18, -15 micromol/L; meanDelta crea CNI: 4, 5, 8, 11 micromol/L at 1, 3, 6, 12 months, p = 0.02). RI improved after switching to SRL and was lower on SRL than on CNI (meanDeltaRI SRL: -0.04, -0.04, -0.03, -0.03; meanDeltaRI CNI: -0.006, 0.004, -0.007, -0.01 after 1, 3, 6, 12 months, p = 0.016). Individual changes of RI correlated significantly with individual changes of crea (r = 0.54, p < 0.001). Conversion from CNI to SRL can ameliorate renal function accompanied by a reduction of intrarenal RI after OLT.

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Section: Discussionsupporting

confidence: 92%

Relationship between renal resistance index and renal function in liver transplant recipients after cessation of calcineurin inhibitor

Eisenberger¹,

Sollinger²,

Stickel

et al. 2009

Clinical Transplantation

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“…In healthy individuals, renal vascular resistance increases after oral administration of cyclosporine A but not after administration of tacrolimus (7). In stable renal transplant recipients, the published findings of effects of cyclosporine A are contradictory (8,9), with recent studies showing no relevant or significant effect of cyclosporine A or tacrolimus on the intrarenal RI of renal allografts (10). Possibly, different drug dosages explain the discrepant findings.…”

Section: Discussionmentioning

confidence: 99%

Reverse Diastolic Intrarenal Flow Due to Calcineurin Inhibitor (CNI) Toxicity

Böger

Rümmele

Mihatsch

et al. 2006

American Journal of Transplantation

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Renal calcineurin inhibitor (CNI) toxicity is a frequent side effect of immunosuppression with CNIs in solid organ transplantation, leading to acute and chronic renal failure. Acute CNI toxicity is due to vasoconstriction of the vasa afferens and efferens and vacuolization of smooth muscle cells with medial hyalinosis, leading to vessel lumen narrowing.Our case had an acute renal failure 8 months after deceased donor kidney transplantation under treatment with tacrolimus, sirolimus and prednisolone. In Doppler sonography, we observed reverse diastolic intrarenal blood flow, reflecting intense vessel narrowing. There were histological signs of acute CNI toxicity. Within days of reducing the tacrolimus trough level, renal function improved markedly and Doppler sonography showed orthograde intrarenal blood flow. This is the first case of functional, Doppler sonographic evidence for CNI-induced, rapidly reversible narrowing of intrarenal vessels. This case illustrates the potential role of tacrolimus and sirolimus dosing in combination therapy to produce severe intrarenal vasoconstriction.

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Changes in Doppler Resistance Indices After Intake of Cyclosporin a in Comparison to Tacrolimus in Patients With Stable Renal Allograft Function.

Cited by 2 publications

References 0 publications

Relationship between renal resistance index and renal function in liver transplant recipients after cessation of calcineurin inhibitor

Relationship between renal resistance index and renal function in liver transplant recipients after cessation of calcineurin inhibitor

Reverse Diastolic Intrarenal Flow Due to Calcineurin Inhibitor (CNI) Toxicity

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