PMID- 24935295
OWN - NLM
STAT- MEDLINE
DCOM- 20150226
LR  - 20140617
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 46
IP  - 5
DP  - 2014 Jun
TI  - Effect of rapamycin on spleen size in longstanding renal transplant recipients.
PG  - 1319-23
LID - S0041-1345(14)00242-5 [pii]
LID - 10.1016/j.transproceed.2014.03.011 [doi]
AB  - BACKGROUND: Based on evidence available in the literature, rapamycin, a mammalian 
      target of rapamycin (mTOR) inhibitor, but not calcineurin inhibitors (CNIs), has 
      been shown to decrease spleen size. Small spleen, in some instances, is 
      associated with hyposplenism, a condition recently reported in patients with 
      longstanding renal transplant. Accordingly, the effect of immunosuppressive drugs 
      on spleen size was evaluated. METHODS: Renal transplant recipients (35 taking 
      mTOR and 68 CNI) were included, in whom a standardized investigation of the 
      kidney allograft and spleen with the use of color Doppler ultrasound was 
      performed and a peripheral smear were reviewed for the presence of Howell-Jolly 
      bodies (HJBs). RESULTS: We enrolled 103 patients (64 men; 66 from a deceased 
      donor). The mean age was 47.7 years (range, 23.0-74.0 y). Mean transplant 
      duration was 1,899 days (range, 181-6,883 d). According to the presence of HJBs, 
      the prevalence of hyposplenism was 47.6% for the entire cohort. The differences 
      between the mTOR and CNI groups regarding sex and the presence of HJBs were not 
      statistically significant (P > .05). Age, creatinine, hemoglobin, leukocytes, 
      platelets, and Doppler parameters in spleen and kidney were similar in both 
      groups (P > .05). mTOR patients had a decreased spleen length size (90.09 +/- 13.02 
      mm vs 111.95 +/- 18.66 mm; P < .001), a longer transplant duration (3,576 +/- 1,594 d 
      vs 1,036 +/- 1,369 d; P < .001) and higher serum cholesterol (227.50 +/- 38.75 mg/dL 
      vs 182.67 +/- 37.74 mg/dL; P < .001) and triglycerides (194.23 +/- 79.88 mg/dL vs 
      148.70 +/- 55.54 mg/dL; P = .003) levels compared with the CNI group. A 
      multivariate analysis showed mTOR inhibitor to be the most important predictor of 
      spleen size. In both the mTOR and CNI groups, the comparison between the 
      subgroups of present and absent HJBs did not show any difference. CONCLUSIONS: 
      The findings of this study suggest that small spleens in transplant recipients 
      may be linked to treatment with an mTOR inhibitor, although this apparently does 
      not compromise splenic function.
CI  - Copyright (c) 2014 Elsevier Inc. All rights reserved.
FAU - Araujo, N C
AU  - Araujo NC
AD  - Division of Nephrology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 
      Brazil. Electronic address: nordeval@oi.com.br.
FAU - Sampaio Goncalves de Lucena, S B
AU  - Sampaio Goncalves de Lucena SB
AD  - Division of Hematology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 
      Brazil.
FAU - da Silveira Rioja, S
AU  - da Silveira Rioja S
AD  - Division of Nephrology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 
      Brazil.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (Immunosuppressive Agents)
RN  - W36ZG6FT64 (Sirolimus)
SB  - IM
MH  - Adult
MH  - Cross-Sectional Studies
MH  - Female
MH  - Humans
MH  - Immunosuppressive Agents/administration & dosage/*pharmacology
MH  - *Kidney Transplantation
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Sirolimus/administration & dosage/*pharmacology
MH  - Spleen/drug effects
EDAT- 2014/06/18 06:00
MHDA- 2015/02/27 06:00
CRDT- 2014/06/18 06:00
PHST- 2014/01/28 00:00 [received]
PHST- 2014/03/14 00:00 [revised]
PHST- 2014/03/27 00:00 [accepted]
PHST- 2014/06/18 06:00 [entrez]
PHST- 2014/06/18 06:00 [pubmed]
PHST- 2015/02/27 06:00 [medline]
AID - S0041-1345(14)00242-5 [pii]
AID - 10.1016/j.transproceed.2014.03.011 [doi]
PST - ppublish
SO  - Transplant Proc. 2014 Jun;46(5):1319-23. doi: 10.1016/j.transproceed.2014.03.011.