{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T09:49:19Z","timestamp":1776851359522,"version":"3.51.2"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In kidney transplantation, it remains unclear whether mammalian target of rapamycin inhibitors (mTORi) improve cardiovascular outcomes\u2014through plaque stabilization and attenuation of left ventricular remodeling\u2014or worsen them by deranging glucose and lipid metabolism. We aimed to assess the true impact of this drug class on major cardiovascular outcomes in a deeply phenotyped cohort with long-term follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>All patients transplanted at our center between 1st June 2013 and 31st December 2019 (n\u00a0=\u00a0845) were screened for inclusion. A total of 492 patients were selected through 1:1 propensity score matching (PSM) based on 18 key donor and recipient variables. All patients received tacrolimus (TAC), steroids, and either mTORi (n\u00a0=\u00a0246) or mycophenolic acid (MPA) (n\u00a0=\u00a0246). The primary outcome was major adverse cardiovascular events (MACE), defined as non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Baseline variables were adequately balanced after PSM (absolute standardized difference\u00a0&amp;lt;0.10). Over a mean follow-up of 4.81\u00a0\u00b1\u00a02.49 years, MACE occurred in 78 patients (15.9%), with no significant difference between the mTORi and MPA groups (HR[95% CI] 0.84[0.54\u20131.30], P\u00a0=\u00a00.443). Subgroup analyses\u2014including patients with diabetes, prior MACE, stable immunosuppression, or pre-transplant ischemia testing\u2014also showed no differences. Independent predictors of MACE were age (HR[95% CI] for upper tertile 2.17[1.38\u20133.42], P\u00a0&amp;lt;\u00a00.001), dialysis vintage (HR[95% CI] for upper tertile 1.91[1.22\u20133.01], P\u00a0=\u00a00.005), prior myocardial infarction (HR[95% CI] 2.12[1.19\u20133.78], P\u00a0=\u00a00.011), and deceased vs. living donor graft (HR[95% CI] 3.42[1.47\u20137.92], P\u00a0=\u00a00.004).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cardiovascular disease after kidney transplantation occurs due to non-modifiable risk factors and does not appear to be related to baseline immunosuppression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfag101","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T12:50:06Z","timestamp":1774443006000},"source":"Crossref","is-referenced-by-count":0,"title":["Neutral impact of mTOR inhibitors on cardiovascular outcomes after kidney transplantation"],"prefix":"10.1093","volume":"19","author":[{"given":"Eul\u00e0lia","family":"Domingo-Pinent","sequence":"first","affiliation":[{"name":"Unidad de Trasplante Renal (UTR), Instituto Cl\u00ednico de Nefrolog\u00eda y Urolog\u00eda (ICNU), Hospital Cl\u00ednic , Barcelona ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judit","family":"Cacho","sequence":"additional","affiliation":[{"name":"Unidad de Trasplante Renal (UTR), Instituto Cl\u00ednico de Nefrolog\u00eda y Urolog\u00eda (ICNU), Hospital Cl\u00ednic , Barcelona ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Cassia","sequence":"additional","affiliation":[{"name":"Unidad de Trasplante Renal (UTR), Instituto Cl\u00ednico de Nefrolog\u00eda y Urolog\u00eda (ICNU), Hospital Cl\u00ednic , Barcelona 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,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"Juarez","sequence":"additional","affiliation":[{"name":"Unidad de Trasplante Renal (UTR), Instituto Cl\u00ednico de Nefrolog\u00eda y Urolog\u00eda (ICNU), Hospital Cl\u00ednic , Barcelona ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7565-2167","authenticated-orcid":false,"given":"\u00c1ngela","family":"Gonzalez-Rojas","sequence":"additional","affiliation":[{"name":"Unidad de Trasplante Renal (UTR), Instituto Cl\u00ednico de Nefrolog\u00eda y Urolog\u00eda (ICNU), Hospital Cl\u00ednic , Barcelona ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1027-7156","authenticated-orcid":false,"given":"Diana","family":"Rodr\u00edguez-Espinosa","sequence":"additional","affiliation":[{"name":"Unidad de Trasplante Renal (UTR), Instituto Cl\u00ednico de Nefrolog\u00eda y Urolog\u00eda (ICNU), Hospital Cl\u00ednic , Barcelona ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5940-8962","authenticated-orcid":false,"given":"Enrique","family":"Montagud-Marrahi","sequence":"additional","affiliation":[{"name":"Unidad de Trasplante Renal (UTR), Instituto Cl\u00ednico de Nefrolog\u00eda y Urolog\u00eda (ICNU), Hospital Cl\u00ednic , Barcelona ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1100-5758","authenticated-orcid":false,"given":"Carolt","family":"Arana","sequence":"additional","affiliation":[{"name":"Unidad de Trasplante Renal (UTR), Instituto Cl\u00ednico de Nefrolog\u00eda y Urolog\u00eda (ICNU), Hospital Cl\u00ednic , Barcelona 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