1
|
Chan M, Silveira L, Patterson DJ, Bock ME, Pietra BA, Everitt MD, Simpson KE, Miyamoto SD, Auerbach SR. Changes in estimated glomerular filtration rate over the first year following repeat heart transplant in children and young adults. Pediatr Transplant 2024; 28:e14651. [PMID: 38015081 DOI: 10.1111/petr.14651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/16/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Renal function is reduced in patients undergoing heart transplant due to hemodynamic compromise, cardiorenal syndrome, and nephrotoxin exposure. No current studies evaluate renal function in retransplants. METHODS We reviewed all heart transplants at our center from 1995 to 2021 and matched first-time heart transplants with retransplants, based on age at transplant, sex, and race. Estimated glomerular filtration rate (eGFR) was derived from CKiD-U25 calculator using creatinine and measured prior to transplant, 1-week post-transplant, 1-3, 6, and 12 months post-transplant, and recent follow-up. Changes in eGFR were measured within and between patients using a piecewise linear mixed effect model with matching. Exploratory univariate analysis was performed to evaluate pre-transplant risk factors for decreased eGFR. RESULTS The unmatched cohort included 393 heart transplant recipients, with 47 being retransplants. Thirty-eight patients in both groups with at least 1 year of follow-up underwent matching. Both retransplants and first-time transplants had an initial decline in eGFR. eGFR rebounded to baseline or above baseline at 1-3 months post-transplant, but eGFR in retransplants remained significantly lower. At 1-year post-transplant, the average eGFR was 67.8 ± 4.3 mL/min/1.73 m2 versus 104.7 ± 4.3 mL/min/1.73 m2 (p < .001) in the retransplants and first-time transplants group, respectively. CONCLUSION This study provides data on anticipated renal trajectory following retransplantation.
Collapse
Affiliation(s)
- Melvin Chan
- Pediatrics, Division of Nephrology, University of Colorado Denver, Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lori Silveira
- Pediatrics, Division of Endocrinology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Margret E Bock
- Pediatrics, Division of Nephrology, University of Colorado Denver, Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Biagio A Pietra
- Congenital Heart Center, University of Florida, Gainesville, Florida, USA
| | - Melanie D Everitt
- Pediatrics, Division of Cardiology, University of Colorado Denver, Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Kathleen E Simpson
- Pediatrics, Division of Cardiology, University of Colorado Denver, Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Shelley D Miyamoto
- Pediatrics, Division of Cardiology, University of Colorado Denver, Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Scott R Auerbach
- Pediatrics, Division of Cardiology, University of Colorado Denver, Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, Colorado, USA
| |
Collapse
|
2
|
Late renal dysfunction after pediatric heart transplantation. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
3
|
Hoskote A, Burch M. Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children. Pediatr Nephrol 2015; 30:905-18. [PMID: 25115875 PMCID: PMC4544563 DOI: 10.1007/s00467-014-2878-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 05/23/2014] [Accepted: 06/03/2014] [Indexed: 01/13/2023]
Abstract
Significant advances in cardiac intensive care including extracorporeal life support have enabled children with complex congenital heart disease and end-stage heart failure to be supported while awaiting transplantation. With an increasing number of survivors after heart transplantation in children, the complications from long-term immunosuppression, including renal insufficiency, are becoming more apparent. Severe renal dysfunction after heart transplant is defined by a serum creatinine level >2.5 mg/dL (221 μmol/L), and/or need for dialysis or renal transplant. The degree of renal dysfunction is variable and is progressive over time. About 3-10 % of heart transplant recipients will go on to develop severe renal dysfunction within the first 10 years post-transplantation. Multiple risk factors for chronic kidney disease post-transplant have been identified, which include pre-transplant worsening renal function, recipient demographics and morbidity, peri-transplant haemodynamics and long-term exposure to calcineurin inhibitors. Renal insufficiency increases the risk of post-transplant morbidity and mortality. Hence, screening for renal dysfunction pre-, peri- and post-transplantation is important. Early and timely detection of renal insufficiency may help minimize renal insults, and allow prompt implementation of renoprotective strategies. Close monitoring and pre-emptive management of renal dysfunction is an integral aspect of peri-transplant and subsequent post-transplant long-term care.
Collapse
Affiliation(s)
- Aparna Hoskote
- Cardiac Intensive Care and ECMO, Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK,
| | - Michael Burch
- Cardiothoracic Unit, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| |
Collapse
|
4
|
Davies RR, Haldeman S, McCulloch MA, Pizarro C. Ventricular assist devices as a bridge-to-transplant improve early post-transplant outcomes in children. J Heart Lung Transplant 2014; 33:704-12. [PMID: 24709269 DOI: 10.1016/j.healun.2014.02.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 02/03/2014] [Accepted: 02/07/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The use of ventricular assist devices (VADs) to bridge pediatric patients to transplant or recovery has been expanding. There are few current pediatric data assessing the impact of VAD support on post-transplant survival. METHODS We performed a retrospective review of all pediatric (≤18 years old, n = 4,028) transplants performed between 1995 and 2011 and contained within the United Network for Organ Sharing data set. Transplants were divided into three eras: early (1995 to 2002, n = 1,450); intermediate (2003 to 2007, n = 1,138); and recent (2008 to 2011, n = 1,440). VADs were present at transplant in 398 patients (9.8%). Outcomes among patients with and without VADs were assessed and compared across eras. RESULTS The use of VADs for bridge to transplant has increased (early 1.1%, intermediate 10.5%, recent 17.9%; p < 0.0001). Mean weight among VAD-supported patients (early 63.5 kg, intermediate 42.3 kg, recent 28.8 kg; p < 0.0001) has decreased during this period. VAD patients <10 kg had an increased risk of stroke (odds ratio [OR] = 4.9, 95% confidence interval [CI] 2.1 to 10.8) compared with non-mechanical support patients. In multivariable analyses, extracorporeal VADs were the only type of VAD associated with higher post-transplant mortality (OR = 3.0, 95% CI 0.8 to 10.6). Other types of VAD had lower mortality (OR = 0.5, 95% CI 0.2 to 1.0). Long-term survival was unaffected by the use of a VAD pre-transplant. CONCLUSIONS Pediatric patients bridged to transplantation with VADs are increasingly younger and smaller. Complication rates remain high among patients <10 kg. Early post-transplant survival among intracorporeal and paracorporeal VAD patients is excellent and better when compared with unsupported patients. The use of short-term support devices is associated with higher post-transplant mortality. Long-term survival is unaffected by VAD use.
Collapse
Affiliation(s)
- Ryan R Davies
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware; Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Shylah Haldeman
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware
| | - Michael A McCulloch
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware; Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christian Pizarro
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware; Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
5
|
Abraham BP, Frazier EA, Morrow WR, Blaszak RT, Devarajan P, Mitsnefes M, Bryant JC, Sachdeva R. Cystatin C and neutrophil gelatinase-associated lipocalin as markers of renal function in pediatric heart transplant recipients. Pediatr Transplant 2011; 15:564-9. [PMID: 21518160 DOI: 10.1111/j.1399-3046.2011.01502.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We hypothesized that use of Schwartz formula underestimates the prevalence of CKD in PHT recipients. This study determined the prevalence and risk factors for CKD in PHT using novel methods-serum cystatin C, CKiD formula, Revised Schwartz formula, s- and u-NGAL. Serum BUN, creatinine, cystatin C and s- and u-NGAL were measured after prospective enrollment. Schwartz formula GFR was compared with novel methods. CKD was defined as CKiD GFR < 90 mL/min/1.73 m(2) . The s- and u-NGAL were compared between those with and without CKD. Potential risk factors for CKD were analyzed. Seventy-nine patients (46 male children or boys), mean age 9.9 ± 5.8 yr formed the study cohort. The prevalence of mild and moderate CKD was 2- to 3-fold higher using novel methods compared to Schwartz formula. u-NGAL and u-NGAL/Cr were significantly higher in patients with CKD. u- and s-NGAL had negative correlation with estimates of GFR. Women were at a higher risk for CKD (odds ratio 8.7) as was longer duration since transplant (p = 0.009). In conclusion, use of novel methods of GFR estimation unmasked 2- to 3-fold increased prevalence of CKD in PHT. Women and those with longer duration since transplant are at higher risk for CKD.
Collapse
Affiliation(s)
- Boban P Abraham
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
LaR Pediatric solid-organ transplantation is an increasingly successful treatment for organ failure. Five- and 10-yr patient survival rates have dramatically improved over the last couple of decades, and currently, over 80% of pediatric patients survive into adolescence and young adulthood. Waiting list mortality has been a concern for liver, heart, and intestinal transplantation, illustrating the importance of transplant as a life-saving therapy. Unfortunately, the success of pediatric transplantation comes at the cost of long-term or late complications that arise as a result of allograft rejection or injury, immunosuppression-related morbidity, or both. As transplant recipients enter adolescence treatment, non-adherence becomes a significant issue, and the medical and psychosocial impacts transition to adulthood not only with regard to healthcare but also in terms of functional outcomes, economic potential, and overall QoL. This review addresses the clinical and psychosocial challenges encountered by pediatric transplant recipients in the current era. A better understanding of pediatric transplant outcomes and adult morbidity and mortality requires further ongoing assessment.
Collapse
Affiliation(s)
- Christopher LaRosa
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | | |
Collapse
|
7
|
Schonder KS, Mazariegos GV, Weber RJ. Adverse effects of immunosuppression in pediatric solid organ transplantation. Paediatr Drugs 2010; 12:35-49. [PMID: 20034340 DOI: 10.2165/11316180-000000000-00000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Solid organ transplantation is a life-saving treatment for end-stage organ failure in children. Immunosuppressant medications are used to prevent rejection of the organ transplant. However, these medications are associated with significant adverse effects that impact growth and development, quality of life (QOL), and sometimes long-term survival after transplantation. Adverse effects can differ between the immunosuppressants, but many result from the overall state of immunosuppression. Strategies to manage immunosuppressant adverse effects often involve minimizing exposure to the drugs while balancing the risk for rejection. Early recognition of immunosuppressant adverse effects may help to reduce morbidities associated with solid organ transplantation, improve QOL, and possibly increase overall patient survival.
Collapse
Affiliation(s)
- Kristine S Schonder
- Department of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy, Pennsylvania 15213, USA.
| | | | | |
Collapse
|
8
|
Guzzo I, Capozza N, Parisi F, Collura G, Diomedi Camassei F, Dello Strologo L. Renal transplant donation from a deceased cardiac graft recipient: a case for marginal donors. Pediatr Transplant 2009; 13:936-9. [PMID: 19170927 DOI: 10.1111/j.1399-3046.2008.01091.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe a case of dual kidney transplant in a highly sensitized 18-yr-old male patient followed for chronic renal failure secondary to focal and segmental glomerulosclerosis. The donor was a six-yr-old boy who had received a cardiac transplant at the age of three months and had been treated with CNIs for over five yr. Renal biopsy performed before the transplant revealed focal sclerosis in 30-40% of the donor's glomeruli. Considering the long expected time on the waiting list for this highly sensitized boy and the absence of prohibited antigens in the donor, we decided to perform the transplant. To increase renal mass, both kidneys were transplanted. Clinical course was good but the patient developed proteinuria, which improved with ramipril. We performed two renal biopsies in the first nine months post-transplant which showed a progressive increase of the glomerulosclerosis. Despite the histology, renal function remains good 24 months after transplant. This is the first report of a transplant using a kidney from a donor who had received long-term CNI treatment. Short-term outcome is satisfactory. We suggest that marginal donors could also be considered for donation in pediatric age for selected groups of patients.
Collapse
Affiliation(s)
- Isabella Guzzo
- Department of Nephrology and Urology, Bambino Gesu Children's Hospital, Institute for Scientific Research, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
9
|
Girnita DM, Webber SA, Zeevi A. Clinical impact of cytokine and growth factor genetic polymorphisms in thoracic organ transplantation. Clin Lab Med 2009; 28:423-40, vi. [PMID: 19028261 DOI: 10.1016/j.cll.2008.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Demographic and clinical risk factors may only partially predict short- and long-term outcomes after thoracic transplantation. The interindividual variability seen in rejection profiles could be related to the recipient's or donor's genetic background. Rejection, either acute or chronic, elicits an alloimmune response that involves a complex network of cytokines, growth factors, adhesion molecules, and other molecules, which may modulate the immune response toward rejection or, conversely, mediate graft acceptance. Herein, the authors discuss the current evidence regarding the importance of genetic polymorphisms as independent predictors of allograft outcome. They believe that pretransplant genotype profiling of patients, in combination with other relevant clinical information, might be useful to predict the risk for posttransplant adverse events and also to facilitate the implementation of individualized immunosuppression.
Collapse
Affiliation(s)
- Diana M Girnita
- Department of Pathology, Thomas E. Starzl Transplant Institute, 200 Lothrop Street, BST, W1558, Pittsburgh, PA 15217, USA
| | | | | |
Collapse
|
10
|
Bharat W, Manlhiot C, McCrindle BW, Pollock-BarZiv S, Dipchand AI. The profile of renal function over time in a cohort of pediatric heart transplant recipients. Pediatr Transplant 2009; 13:111-8. [PMID: 18093086 DOI: 10.1111/j.1399-3046.2007.00848.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To assess the burden over time of renal dysfunction in pediatric heart transplant patients using an objective measure on an annual basis for serial comparison. GFR was measured at regular interval by nuclear medicine scintigraphy. Results were analyzed in relation to age, time post-transplantation, gender, and average calcineurin-inhibitor dose for the first two months post-transplantation. Results were compared with cGFR using the Schwartz equation. A total of 91 patients (56 males) transplanted between 1990 and 2004 underwent 373 GFR measurements. Median age at transplantation was 3.3 yr (birth - 17.8). Median first GFR at 0.7 yr (0.1-4.1) post-transplant was normal (94 mL/kg/1.73 m(2)). Freedom from at least mild renal insufficiency was 84% and 33% at one and five years post-transplant. Females had better renal function early post-transplant (GFR 105 mL/min/1.73 m(2)) but an increased probability of an abnormal GFR over time. Higher calcineurin inhibitor dose in the first two months post-transplantation was associated with an increasing probability of an abnormal GFR over time. The cGFR overestimated the measured GFR by 33 +/- 26 mL/kg/1.73 m(2). Renal insufficiency is an important morbidity after pediatric transplantation with the majority of patients experiencing at least mild renal dysfunction. Calculated GFR significantly underestimates the burden of renal insufficiency in this patient population.
Collapse
Affiliation(s)
- Winston Bharat
- Labatt Family Heart Centre, Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | | | | | | |
Collapse
|
11
|
Tredger JM, Brown NW, Dhawan A. Calcineurin inhibitor sparing in paediatric solid organ transplantation : managing the efficacy/toxicity conundrum. Drugs 2008; 68:1385-414. [PMID: 18578558 DOI: 10.2165/00003495-200868100-00004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Despite their efficacy, the calcineurin inhibitors (CNIs) ciclosporin and tacrolimus carry a risk of debilitating adverse effects, especially nephrotoxicity, that affect the long-term outcome and survival of children who are given organ transplants. Simple reduction in dosage of CNI has little or no long-term benefit on their adverse effects, and complete withdrawal without threatening graft outcome may only be possible after liver transplantation. Until the last decade, the only option was to increase corticosteroid and/or azathioprine doses, which imposed additional long-term hazards. Considered here are the emerging generation of new agents offering an opportunity for improving long-term graft survival, minimizing CNI-related adverse events and ensuring patient well-being.A holistic, multifaceted strategy may need to be considered - initial selection and optimized use and monitoring of immunosuppressant regimens, early recognition of indicators of patient and graft dysfunction, and, where applicable, early introduction of CNI-sparing regimens facilitating CNI withdrawal. The evidence reviewed here supports these approaches but remains far from definitive in paediatric solid organ transplantation. Because de novo immunosuppression uses CNI in more than 93% of patients, reduction of CNI-related adverse effects has focused on CNI sparing or withdrawal.A recurring theme where sirolimus and mycophenolate mofetil have been used for this purpose is the importance of their early introduction to limit CNI damage and provide long-term benefit: for example, long-term renal function critically reflects that at 1 year post-transplant. While mycophenolic acid shows advantages over sirolimus in preserving renal function because the latter is associated with proteinuria, sirolimus appears the more potent immunosuppressant but also impairs early wound healing. The use of CNI-free immunosuppressant regimens with depleting or non-depleting antibodies plus sirolimus and mycophenolic acid needs much wider investigation to achieve acceptable rejection rates and conserve renal function. The adverse effects of the alternative immunosuppressants, particularly the dyslipidaemia associated with sirolimus, needs to be minimized to avoid replacing one set of adverse effects (from CNIs) with another. While we can only conjecture that judicious combinations with the second generation of novel immunosuppressants currently in development will provide these solutions, a rationale of low-dose therapy with multiple immunosuppressants acting by complementary mechanisms seems to hold the promise for efficacy with minimal toxicity until the vision of tolerance achieves reality.
Collapse
Affiliation(s)
- J Michael Tredger
- Institute of Liver Studies, King's College Hospital and King's College London School of Medicine, London, UK.
| | | | | |
Collapse
|
12
|
Girnita DM, Burckart G, Zeevi A. Effect of cytokine and pharmacogenomic genetic polymorphisms in transplantation. Curr Opin Immunol 2008; 20:614-25. [PMID: 18706500 PMCID: PMC2739872 DOI: 10.1016/j.coi.2008.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Revised: 08/01/2008] [Accepted: 08/04/2008] [Indexed: 12/13/2022]
Abstract
Consolidating the information that we have on pharmacogenetics and on cytokine genetics to produce patient-oriented individualized drug regimens is an important challenge in transplantation medicine. Using a multi-variant approach based on genetic profile and other relevant clinical factors a score system may be developed to predict the severity of rejection, infection, or other complications associated with transplantation. The ultimate goal of these studies is to improve patient outcome through individualized drug regimens.
Collapse
Affiliation(s)
- Diana M Girnita
- Department of Pathology, Thomas E Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA 15213
| | - Gilbert Burckart
- Office of Clinical Pharmacology, Office of Translational Science, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Adriana Zeevi
- Department of Pathology, Thomas E Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA 15213
| |
Collapse
|
13
|
Pethig K, Hornig B, Bara C, Schieffer B, Haverich A, Sachse A. Eprosartan in the Primary Prevention of Cardiac Allograft Vascular Disease: A Double-Blind Prospectively Randomized Study using Intravascular Ultrasound. J Int Med Res 2008; 36:1022-31. [DOI: 10.1177/147323000803600520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The angiotensin blocker (ARB) eprosartan (600 mg once daily) and the calcium antagonist diltiazem (90 mg twice daily) were studied in a 24-month prospective, randomized, double-blind trial involving 53 heart transplant patients. The study compared their effects on the development of post-transplant cardiac allograft vasculopathy, a condition that frequently impairs long-term post-transplantation survival and where angiotensin blockers might be expected to play a preventive role. From baseline to month 12, the mean plaque volume increased by 7.7 mm3 for eprosartan-treated patients and by 34.4 mm3 for diltiazem-treated patients, but the eprosartan-related trend for reduced myointimal hyperplasia was not statistically significant. The trend in favour of eprosartan for secondary parameters (mean intimal index, vessel volume, lumen volume and coronary flow reserve) also failed to reach significance. The lack of effect might be due to a lower than planned sample size and observation periods due to recruitment difficulties. A larger study is required to confirm these preliminary findings.
Collapse
Affiliation(s)
- K Pethig
- Department of Cardiology, Evangelisches Krankenhaus, Hamm, Germany
| | - B Hornig
- Department of Cardiology, St Claraspital, Basel, Switzerland
| | - C Bara
- Department of Cardiothoracic Surgery
| | - B Schieffer
- Department of Cardiology, Hannover Medical School, Hannover, Germany
| | | | - A Sachse
- Solvay Arzneimittel GmbH, Hannover, Germany
| |
Collapse
|
14
|
Renal Transplantation After Previous Pediatric Heart Transplantation. J Heart Lung Transplant 2008; 27:217-21. [DOI: 10.1016/j.healun.2007.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 10/24/2007] [Accepted: 10/25/2007] [Indexed: 11/22/2022] Open
|