Focus Topic: Left Atrial Mechanics and RemodelingClinical InvestigationsLeft Atrial Structural and Functional Response in Kidney Transplant Recipients Treated With Mesenchymal Stromal Cell Therapy and Early Tacrolimus Withdrawal
Section snippets
Study Design and Population
In this echocardiographic subanalysis of the TRITON trial (NCT03398681),2 patients who underwent transthoracic echocardiography with speckle-tracking analysis at 4 and 24 weeks post-transplantation were included. In brief, the TRITON trial was a 24-week randomized, prospective, single-center clinical study investigating the combination of MSC therapy and early tacrolimus withdrawal as a novel immunosuppressive strategy after kidney transplantation.2 A total of 70 recipients of a first renal
Results
Of 70 patients initially enrolled in the trial, 13 subjects were excluded due to abnormal MSC growth (n = 4), contraindication for MSC therapy during the COVID-19 pandemic (n = 1), impossibility of obtaining a baseline renal biopsy (n = 3), withdrawal of the informed consent (n = 4), and contraindication for prednisone usage (n = 1). Therefore, the study population was composed by 57 patients, which were randomly assigned to the MSC group (n = 29) or control group (n = 28). Transthoracic
Discussion
The present study showed that MSC therapy combined with early discontinuation of CNIs prevents progressive LA dilation and dysfunction in recipients of kidney transplantation compared with a tacrolimus-based regimen. Notably, LAVImin and LA reservoir strain emerged as more sensitive markers of LA reverse remodeling in comparison to LAVImax.
Patients with CKD as well as kidney transplant recipients are at increased risk of cardiovascular disease.11 Current immunosuppressive treatments,
Conclusion
The combination of MSC therapy and early CNIs withdrawal may prevent LA structural and functional remodeling in the first 6 months after kidney transplantation compared with a standard tacrolimus regimen. The early response of LAVImin and LA reservoir strain in patients treated by MSC strategy supports their value as more sensitive markers of LA reverse remodeling compared with LAVImax.
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Conflicts of Interest: The Department of Cardiology, Heart Lung Center, Leiden University Medical Center, received research grants from Abbott Vascular, Bayer, Bioventrix, Medtronic, Biotronik, Boston Scientific, GE Healthcare, and Edwards Lifesciences. J.B. received speaker fees from Abbott Vascular and Edwards Lifesciences. N.A.M. received speaker fees from Abbott Vascular and GE Healthcare and a research grant from Alnylam and has been on the Medical Advisory Board of Philips Ultrasound. V.D. received speaker fees from Abbott Vascular, Medtronic, Edwards Lifesciences, MSD, and GE Healthcare. The remaining authors have nothing to disclose in relation to this paper.
Thomas H. Marwick, MD, PhD, MPH, served as guest editor for this report.