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Barrett LDG, Ryckman KK, Goedken AM, Steinbach EJ, van der Plas E, Beasley G, Khan RS, Exil V, Axelrod DA, Harshman LA. Subsequent kidney transplant after pediatric heart transplant: Prevalence and risk factors. Am J Transplant 2024; 24:1267-1278. [PMID: 38431077 DOI: 10.1016/j.ajt.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
Pediatric heart failure and transplantation carry associated risks for kidney failure and potential need for kidney transplant following pediatric heart transplantation (KT/pHT). This retrospective, United Network of Organ Sharing study of 10,030 pediatric heart transplants (pHTs) from 1987 to 2020 aimed to determine the incidence of waitlisting for and completion of KT/pHT, risk factors for KT/pHT, and risk factors for nonreceipt of a KT/pHT. Among pHT recipients, 3.4% were waitlisted for KT/pHT (median time of 14 years after pHT). Among those waitlisted, 70% received a KT/pHT, and 18% died on the waitlist at a median time of 0.8 years from KT/pHT waitlisting (median age of 20 years). Moderate-high sensitization at KT/pHT waitlisting (calculated panel reactive antibody, ≥ 20%) was associated with a lower likelihood of KT/pHT (adjusted hazard ratio, 0.67; 95% confidence interval, 0.47-0.95). Waitlisting for heart transplantation simultaneously with kidney transplant (adjusted hazard ratio, 3.73; 95% confidence interval, 2.01-6.92) was associated with increased risk of death on the KT/pHT waitlist. While the prevalence of KT/pHT is low, there is substantial mortality among those waitlisted for KT/pHT. These findings suggest a need to consider novel risk factors for nonreceipt of KT/pHT and death on the waitlist in prioritizing criteria/guidelines for simultaneous heart-kidney transplantation.
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Affiliation(s)
- Lucas D G Barrett
- Medical Scientist Training Program, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA; University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Kelli K Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA; Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, Bloomington, Indiana, USA
| | - Amber M Goedken
- University of Iowa College of Pharmacy, Iowa City, Iowa, USA
| | - Emily J Steinbach
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Ellen van der Plas
- Psychiatry Department, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA; Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; Department of Hematology/Oncology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Gary Beasley
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Rabia S Khan
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of California, Los Angeles Health Sciences, Los Angeles, California, USA
| | - Vernat Exil
- Division of Pediatrics, Cardiology, Saint Louis University, St. Louis, Missouri, USA
| | - David A Axelrod
- Department of Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Lyndsay A Harshman
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA.
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Randhawa MK, Sultana S, Stib MT, Nagpal P, Michel E, Hedgire S. Role of Radiology in Assessment of Postoperative Complications of Heart Transplantation. Radiol Clin North Am 2024; 62:453-471. [PMID: 38553180 DOI: 10.1016/j.rcl.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Heart transplantation is a pivotal treatment of end-stage heart failure, and recent advancements have extended median posttransplant life expectancy. However, despite the progress in surgical techniques and medical treatment, heart transplant patients still face complications such as rejection, infections, and drug toxicity. CT is a reliable tool for detecting most of these complications, whereas MR imaging is particularly adept at identifying pericardial pathologies and signs of rejection. Awareness of these nuances by radiologists, cardiologists, and surgeons is desired to optimize care, reduce morbidities, and enhance survival.
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Affiliation(s)
- Mangun K Randhawa
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sadia Sultana
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew T Stib
- Division of Cardiothoracic Imaging, Department of Radiology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Prashant Nagpal
- Division of Cardiovascular Imaging, Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Eriberto Michel
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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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.
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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
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Chavali S, Barua S, Adji A, Robson D, Raven LM, Greenfield JR, Eckford H, Macdonald PS, Hayward CS, Muthiah K. Safety and tolerability of sodium-glucose cotransporter-2 inhibitors in bridge-to-transplant patients supported with centrifugal-flow left ventricular assist devices. Int J Cardiol 2023; 391:131259. [PMID: 37574028 DOI: 10.1016/j.ijcard.2023.131259] [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: 03/29/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The safety and tolerability of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with end-stage heart failure supported with left-ventricular-assist-devices (LVADs), irrespective of diabetes mellitus, is not known. METHODS A retrospective analysis of 31 outpatients implanted with LVADs as bridge-to-transplant (BTT) was conducted. Patients with biventricular support, aged under 18 years, who were discharged from the index hospitalisation, or were prescribed SGLT2i prior to their first outpatient clinic were excluded. Patient demographics, laboratory studies, pump haemodynamic and adverse event data was collected. RESULTS Sixteen (51.6%) of 31 patients were prescribed SGLT2i over median 101.5 days (37.5-190.8). No patients discontinued SGLT2i use or reported attributable adverse symptoms. No significant differences between patients prescribed SGLT2i compared to those SGLT2i-naïve were seen in: [1] renal function; [2] weight; [3] mean arterial pressure. There were numerically lower infection-related (n = 4 vs 7, HR 0.32 (0.08-1.28), p = 0.11) and haemocompatibility-related (n = 3 vs 4, HR 0.52 (0.09-2.83), p = 0.45) adverse events in the SGLT2i group, albeit non-significant. CONCLUSIONS We found SGLT2i to be safe and well-tolerated in the BTT LVAD cohort with no significant difference in rates of infection or haemocompatibility-related adverse events with SGLT2i use. Larger studies will inform further beneficial effects of SGLT2i prescription in this cohort.
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Affiliation(s)
- Sanjay Chavali
- St Vincent's Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent's Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Sumita Barua
- St Vincent's Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent's Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Audrey Adji
- St Vincent's Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent's Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia
| | | | - Lisa M Raven
- St Vincent's Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent's Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Clinical Diabetes, Appetite and Metabolism Laboratory, Garvan Institute of Medical Research, Sydney, Australia
| | - Jerry R Greenfield
- St Vincent's Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent's Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Clinical Diabetes, Appetite and Metabolism Laboratory, Garvan Institute of Medical Research, Sydney, Australia
| | - Hunter Eckford
- St Vincent's Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Peter S Macdonald
- St Vincent's Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent's Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Christopher S Hayward
- St Vincent's Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent's Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Kavitha Muthiah
- St Vincent's Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent's Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia.
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Lai M, Aras MA, Park M. Post-transplant ejection fraction and renal failure in cardiac transplant recipients: An analysis of the OPTN database. Clin Transplant 2023; 37:e14881. [PMID: 36504467 DOI: 10.1111/ctr.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/11/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite improved life expectancy from a heart transplant, transplant recipients remain at high risk for renal dysfunction and failure, including end-stage kidney disease (ESKD). The onset of ESKD is a poor prognostic marker and is associated with increased mortality in this setting, as in others. There is a need to identify risk factors for ESKD among heart transplant recipients in contemporary settings. METHODS We conducted an analysis of adult heart transplant recipients transplanted between 2008 and 2021 in the Organ Procurement and Transplantation Network database. 22 737 adult recipients of heart transplants alone were included in this analysis. We examined LVEF measured 1 year after transplant, and LVEF updated annually for association with ESKD using multivariate Cox regression models. RESULTS LVEF at 1-year after transplant was associated with ESKD in multivariate models (Hazard Ratio 1.33 per 10-unit decrease, 95% CI 1.23-1.43, p < .001). In multivariate models using categorized LVEF, mildly reduced ejection fraction (EF 40%-50%) was associated with ESKD (HR 1.76, 95% CI 1.45-2.14, p < .001), as was reduced ejection fraction (EF < 40%, HR 2.86, 95% CI 2.01-4.07, p < .001), relative to individuals with preserved ejection fraction (EF > 50%). These associations were consistent when using annually updated ejection fraction. CONCLUSIONS Post-transplant left ventricular ejection fraction has value in predicting end stage kidney disease among adults who receive heart transplants alone. LVEF is routinely measured as part of contemporary post heart transplant care, and a diminished LVEF should signal to clinicians that a recipient is at increased risk of renal failure.
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Affiliation(s)
- Mason Lai
- School of Medicine, University of California, San Francisco, California, USA
| | - Mandar A Aras
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, USA
| | - Meyeon Park
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
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López-López I, López AIR, Prado JMAD, Benot AR, Cabrera SS, Morales MLA. Prevalence of Chronic Kidney Disease After Heart Transplant: A Single Center Experience. Transplant Proc 2022. [DOI: 10.1016/j.transproceed.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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López-Ibor JV, Citores MJ, Portoles J, Gómez-Bueno M, Sánchez-Sobrino B, Muñoz A, Cuervas-Mons V, Segovia-Cubero J. Role of TGF-β1 +869T>C polymorphism in renal dysfunction one year after heart transplantation. J Heart Lung Transplant 2022; 41:1672-1678. [DOI: 10.1016/j.healun.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 08/01/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022] Open
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Jeon J, Park H, Kim Y, Kang D, Lee JE, Huh W, Guallar E, Cho J, Jang HR. Prognostic Factors of Renal Outcomes after Heart Transplantation: A Nationwide Retrospective Study. J Clin Med 2021; 10:jcm10215110. [PMID: 34768634 PMCID: PMC8584983 DOI: 10.3390/jcm10215110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Renal dysfunction after heart transplantation (HT) is associated with poor survival. We investigated the predictive factors of renal outcomes after HT using nationwide cohort data. In this retrospective cohort study using the Health Insurance Review and Assessment database of Korea, 654 patients who received HT between 2008 and 2016 and survived until discharge after HT were analyzed. The median (interquartile range) age was 52 (40-60) years, and 68.1% were male. Perioperative renal replacement therapy (RRT) was performed in 27.8% of patients. During 2.8 years of median followup, end-stage kidney disease (ESKD) developed in 12 patients (1.8%). In a fully adjusted model, RRT > 3 weeks, the use of inotropes/vasopressors and non-use of ACEi/ARB were associated with ESKD. Preexisting renal disease tended to be associated with ESKD. Among the 561 patients without preexisting CKD, 104 (18.5%) developed chronic kidney disease (CKD). Age, extracorporeal membrane oxygenation, and RRT were associated with the development of CKD after HT. Our nationwide cohort study demonstrated that perioperative RRT was a predictor of poor renal outcomes after HT. These results suggest that an active renoprotective strategy is required during the perioperative period.
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Affiliation(s)
- Junseok Jeon
- Division of Nephrology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.E.L.); (W.H.)
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.P.); (Y.K.); (D.K.); (E.G.)
| | - Youngha Kim
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.P.); (Y.K.); (D.K.); (E.G.)
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.P.); (Y.K.); (D.K.); (E.G.)
| | - Jung Eun Lee
- Division of Nephrology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.E.L.); (W.H.)
| | - Wooseong Huh
- Division of Nephrology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.E.L.); (W.H.)
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.P.); (Y.K.); (D.K.); (E.G.)
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.P.); (Y.K.); (D.K.); (E.G.)
- Correspondence: (J.C.); (H.R.J.); Tel.: +82-2-3410-6639 (J.C.); +82-2-3410-0782 (H.R.J.)
| | - Hye Ryoun Jang
- Division of Nephrology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.E.L.); (W.H.)
- Correspondence: (J.C.); (H.R.J.); Tel.: +82-2-3410-6639 (J.C.); +82-2-3410-0782 (H.R.J.)
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Holzhauser L, Clerkin KJ, Fujino T, Alenghat FJ, Raikhelkar J, Kim G, Sayer G, Uriel N. Donor-derived cell-free DNA is associated with cardiac allograft vasculopathy. Clin Transplant 2021; 35:e14206. [PMID: 33368611 PMCID: PMC10040222 DOI: 10.1111/ctr.14206] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role of donor-derived cell-free DNA (dd-cfDNA) in screening for cardiac allograft vasculopathy (CAV) is unknown. We hypothesized that dd-cfDNA correlates with CAV, markers of inflammation, and angiogenesis in stable heart transplant (HT) recipients. METHODS Sixty-five HT recipients ≥2 years post-transplant, without recent rejection, were stratified by high (≥0.12%) versus low levels (<0.12%) of dd-cfDNA. A targeted amplification, next-generation sequencing assay (AlloSure® ; CareDx, Inc.) was used to detect dd-cfDNA. Peripheral blood inflammatory and angiogenesis markers were assessed using a multiplex immunoassay system (Bioplex® ). RESULTS Of 65 patients, 58 patients had a known CAV status and were included. Thirty had high levels of dd-cfDNA (≥0.12%), and 28 had low levels (<0.12%). CAV was present in 63% of patients with high dd-cfDNA vs. 35% with low dd-cfDNA (p = .047). Donor-specific antibodies were present in 25% of patients with high dd-cfDNA vs. 3.8% in those with low dd-cfDNA (p = .03). There were no differences in rejection episodes, inflammatory, or angiogenesis markers. Importantly, dd-cfDNA levels were not different when stratified by time post-transplant. CONCLUSIONS Higher dd-cfDNA levels were associated with CAV in stable chronic HT recipients. Further studies are warranted to investigate a possible association between dd-cfDNA levels and CAV severity and whether dd-cfDNA can predict CAV progression.
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Affiliation(s)
- Luise Holzhauser
- Department of Cardiology, University of Chicago, Chicago, IL, USA
| | - Kevin J Clerkin
- Department of Medicine, Milstein Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Takeo Fujino
- Department of Cardiology, University of Chicago, Chicago, IL, USA
| | | | - Jayant Raikhelkar
- Department of Medicine, Milstein Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Gene Kim
- Department of Cardiology, University of Chicago, Chicago, IL, USA
| | - Gabriel Sayer
- Department of Medicine, Milstein Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Nir Uriel
- Department of Medicine, Milstein Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Bayne J, Francke M, Ma E, Rubin GA, Avula UMR, Baksh H, Givens R, Wan EY. Increased Incidence of Chronic Kidney Injury in African Americans Following Cardiac Transplantation. J Racial Ethn Health Disparities 2020; 8:1435-1446. [PMID: 33113077 DOI: 10.1007/s40615-020-00906-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study examined whether African American race was associated with an elevated risk of chronic kidney disease (CKD) post-cardiac transplantation. BACKGROUND CKD often occurs after cardiac transplantation and may require renal replacement therapy (RRT) or renal transplant. African American patients have a higher risk for kidney disease as well as worse post-cardiac transplant morbidity and mortality. It is unclear, however, if there is a propensity for African Americans to develop CKD after cardiac transplant. METHODS The Institutional Review Board of Columbia University Medical Center approved the retrospective study of 151 adults (57 African American and 94 non-African American) who underwent single-organ heart transplant from 2013 to 2016. The primary outcome was a decrease in estimated glomerular filtration rate (eGFR), development of CKD, and end-stage renal disease (ESRD) requiring RRT after 2 years. RESULTS African American patients had a significant decline in eGFR post-cardiac transplant compared to non-African American patients (- 34 ± 6 vs. - 20 ± 4 mL/min/1.73 m2, p < 0.0006). African American patients were more likely to develop CKD stage 2 or worse (eGFR < 90 mL/min/1.73 m2) than non-African American patients (81% vs. 59%, p < 0.0005). CONCLUSIONS This is the first study to report that African American patients are at a significantly higher risk for eGFR decline and CKD at 2 years post-cardiac transplant. Future investigation into risk reduction is necessary for this patient population.
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Affiliation(s)
- Joseph Bayne
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael Francke
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Elaine Ma
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA
| | - Geoffrey A Rubin
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA
| | - Uma Mahesh R Avula
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA
| | - Haajra Baksh
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA
| | - Raymond Givens
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA.
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11
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Nelson LM, Rossing K, Ihlemann N, Boesgaard S, Engstrøm T, Gustafsson F. Intravascular ultrasound-guided selection for early noninvasive cardiac allograft vasculopathy screening in heart transplant recipients. Clin Transplant 2020; 34:e14124. [PMID: 33068292 DOI: 10.1111/ctr.14124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Noninvasive screening for cardiac allograft vasculopathy (CAV) instead of invasive coronary angiography (ICA) within the first 3 to 5 years after heart transplantation (HTx) is controversial. We evaluated a strategy of intravascular ultrasound (IVUS)-guided conversion to early noninvasive screening post-HTx. METHODS A single-center study of 103 consecutive HTx recipients from 2008 to 2018 undergoing ICA at 1 year post-HTx. Of 88 patients with normal 1-year ICA, sixty-six patients underwent IVUS examination for risk stratification by maximal intimal thickness (MIT) into (i) low-risk group (MIT < 0.5 mm) (n = 41, 62%) followed noninvasively versus (ii) high-risk group (MIT ≥ 0.5 mm) (n = 25, 38%) followed with yearly ICA. Both groups underwent ICA at year 5 post-HTx. We evaluated a combined endpoint of angiographic CAV and death at 5-year follow-up post-HTx. RESULTS Median (IQR) age was 51 (33-60) years, and 62% were male. Follow-up was 1443 (1125-1456) days. Survival free from angiographic CAV (Kaplan-Meier) differed significantly between groups (log-rank p < .0001). A subgroup of 27 patients completed ICA at year 5, and the proportion of angiographic CAV was significantly lower in low-risk patients (p < .0001). CONCLUSION IVUS-guided selection for early noninvasive CAV screening appears to be safe and holds promise as a novel strategy for early risk stratification and CAV surveillance post-HTx.
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Affiliation(s)
- Laerke Marie Nelson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nikolaj Ihlemann
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Boesgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study. J Clin Med 2020; 9:jcm9082455. [PMID: 32751950 PMCID: PMC7464655 DOI: 10.3390/jcm9082455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term survival and risk factors of dialysis were investigated. Patients who had undergone dialysis were stratified to early or late dialysis for subgroup analysis. The mean follow-up was five years, the incidence of dialysis was 28.4% (21% early dialysis and 7.4% late dialysis). The dialysis cohort had higher overall mortality compared with the non-dialysis cohort. The hazard ratios of mortality in patients with dialysis were 3.44 (95% confidence interval (CI), 2.73–4.33) for all dialysis patients, 3.58 (95% CI, 2.74–4.67) for early dialysis patients, and 3.27 (95% CI, 2.44–4.36; all p < 0.001) for late dialysis patients. Patients with diabetes mellitus, chronic kidney disease, acute kidney injury, and coronary artery disease were at higher risk of renal failure requiring dialysis. Cardiomyopathy, hepatitis B virus infection, and hyperlipidemia treated with statins were associated with a lower risk of renal dysfunction requiring early dialysis. The use of Sirolimus and Mycophenolate mofetil was associated with a lower incidence of late dialysis. Renal dysfunction requiring dialysis after heart transplantation is common in Taiwan. Early and late dialysis were both associated with an increased risk of mortality in heart transplant recipients.
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13
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Melvinsdottir I, Foley DP, Hess T, Gunnarsson SI, Kohmoto T, Hermsen J, Johnson MR, Murray D, Dhingra R. Heart and kidney transplant: should they be combined or subsequent? ESC Heart Fail 2020; 7:2734-2743. [PMID: 32608197 PMCID: PMC7524231 DOI: 10.1002/ehf2.12864] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/25/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023] Open
Abstract
AIMS End-stage heart failure patients often present with severe kidney failure and have limited treatment options. We compared the clinical characteristics and outcomes among end-stage heart and kidney failure patients who underwent combined heart and kidney transplant (HKTx) with those who underwent kidney transplant after heart transplant (KAH). METHODS AND RESULTS All patients from 2007-2016 who underwent combined HKTx (n = 715) and those who underwent KAH (n = 130) using the United Network for Organ Sharing database were included. Kaplan-Meier curves and Cox models compared survivals and identified predictors of death. Number of combined HKTx performed annually in United States increased from 59 in 2007 to 146 in 2016 whereas KAH decreased from 34 in 2007 to 6 in 2016. Among KAH patients, average wait time for kidney transplant was 3.0 years, time to dialysis or to kidney transplant after heart transplant did not differ with varying severity of kidney disease at baseline (P for both >0.05). Upon follow-up (mean 3.5 ± 2.7 years), 151 patients died. In multivariable models, patients who underwent combined HKTx had 4.7-fold greater risk of death [95% confidence interval (CI) 2.4-9.4) than KAH patients upon follow up. A secondary analysis using calculation of survival only after kidney transplant for KAH patients still conferred higher risk for combined HKTx patients [hazard ratio (HR) 2.6 95% CI 1.33-5.15]. In subgroup analyses after excluding patients on dialysis (HR 3.99 95% CI 1.98-8.04) and analysis after propensity matching for age, gender, and glomerular filtration rate (HR 3.01 95% CI 1.40-6.43) showed similar and significantly higher risk for combined HKTx patients compared with KAH patients. Lastly, these results also remained unchanged after excluding transplant centres who performed only one type of procedure preferentially, i.e. HKTx or KAH (HR 4.70 95% CI 2.35-9.42). CONCLUSIONS National registry data show continual increase in combined HKTx performed annually in the United States but inferior survival compared with KAH patients. Differences in patient characteristics or level of kidney dysfunction at baseline do not explain these poor outcomes among HKTx patients compared with KAH patients. Consensus guidelines are greatly needed to identify patients who may benefit more from dual organ transplants.
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Affiliation(s)
- Inga Melvinsdottir
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - David P Foley
- Division of Transplantation, Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Timothy Hess
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Sverrir I Gunnarsson
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Takushi Kohmoto
- Division of Cardiac Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Cardiac Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Joshua Hermsen
- Division of Cardiac Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Maryl R Johnson
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - David Murray
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Ravi Dhingra
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
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14
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Wang L, Wang T, Rushton SN, Parry G, Dark JH, Sheerin NS. The impact of severe acute kidney injury requiring renal replacement therapy on survival and renal function of heart transplant recipients - a UK cohort study. Transpl Int 2020; 33:1650-1666. [PMID: 32542834 DOI: 10.1111/tri.13675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/30/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023]
Abstract
Severe acute kidney injury (AKI), defined as requiring renal replacement therapy (RRT), is associated with higher mortality postheart transplantation, but its long-term renal consequences are not known. Anonymized data of 3365 patients, who underwent heart transplantation between 1995 and 2017, were retrieved from the UK Transplant Registry. Multivariable binary logistic regression was performed to identify risk factors for severe AKI requiring RRT, Kaplan-Meier analysis to compare survival and renal function deterioration of the RRT and non-RRT groups, and multivariable Cox regression model to identify predicting factors of mortality and end-stage renal disease (ESRD). 26.0% of heart recipients received RRT post-transplant. The RRT group has lower survival rates at all time points, especially in the immediate post-transplant period. However, conditional on 3 months survival, older age, diabetes and coronary heart disease, but not post-transplant RRT, were the risk factors for long-term survival. The predicting factors for ESRD were insulin-dependent diabetes, renal function at transplantation, eGFR decline in the first 3 months post-transplant, post-transplant severe AKI and transplantation era. Severe AKI requiring RRT post-transplant is associated with worse short-term survival, but has no impact on long-term mortality. It also accelerates recipients' renal function deterioration in the long term.
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Affiliation(s)
- Lu Wang
- Newcastle upon Tyne Hospitals NHS Foundation Turst, Newcastle upon Tyne, UK.,Translational and Cinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tengyao Wang
- Statistics Science, University College London, London, UK
| | - Sally N Rushton
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Gareth Parry
- Newcastle upon Tyne Hospitals NHS Foundation Turst, Newcastle upon Tyne, UK
| | - John H Dark
- Translational and Cinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Neil S Sheerin
- Newcastle upon Tyne Hospitals NHS Foundation Turst, Newcastle upon Tyne, UK.,Translational and Cinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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15
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Estimated Glomerular Filtration Rate at Transplant Listing and Other Predictors of Post-Heart Transplant Mortality and the Development of ESRD. Transplantation 2020; 104:2444-2452. [DOI: 10.1097/tp.0000000000003159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Roest S, Hesselink DA, Klimczak-Tomaniak D, Kardys I, Caliskan K, Brugts JJ, Maat APWM, Ciszek M, Constantinescu AA, Manintveld OC. Incidence of end-stage renal disease after heart transplantation and effect of its treatment on survival. ESC Heart Fail 2020; 7:533-541. [PMID: 32022443 PMCID: PMC7160492 DOI: 10.1002/ehf2.12585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/30/2019] [Accepted: 11/12/2019] [Indexed: 01/06/2023] Open
Abstract
Aims Many heart transplant recipients will develop end‐stage renal disease in the post‐operative course. The aim of this study was to identify the long‐term incidence of end‐stage renal disease, determine its risk factors, and investigate what subsequent therapy was associated with the best survival. Methods and results A retrospective, single‐centre study was performed in all adult heart transplant patients from 1984 to 2016. Risk factors for end‐stage renal disease were analysed by means of multivariable regression analysis and survival by means of Kaplan–Meier. Of 685 heart transplant recipients, 71 were excluded: 64 were under 18 years of age and seven were re‐transplantations. During a median follow‐up of 8.6 years, 121 (19.7%) patients developed end‐stage renal disease: 22 received conservative therapy, 80 were treated with dialysis (46 haemodialysis and 34 peritoneal dialysis), and 19 received a kidney transplant. Development of end‐stage renal disease (examined as a time‐dependent variable) inferred a hazard ratio of 6.45 (95% confidence interval 4.87–8.54, P < 0.001) for mortality. Tacrolimus‐based therapy decreased, and acute kidney injury requiring renal replacement therapy increased the risk for end‐stage renal disease development (hazard ratio 0.40, 95% confidence interval 0.26–0.62, P < 0.001, and hazard ratio 4.18, 95% confidence interval 2.30–7.59, P < 0.001, respectively). Kidney transplantation was associated with the best median survival compared with dialysis or conservative therapy: 6.4 vs. 2.2 vs. 0.3 years (P < 0.0001), respectively, after end‐stage renal disease development. Conclusions End‐stage renal disease is a frequent complication after heart transplant and is associated with poor survival. Kidney transplantation resulted in the longest survival of patients with end‐stage renal disease.
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Affiliation(s)
- Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis A Hesselink
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dominika Klimczak-Tomaniak
- Department of Cardiology, Hypertension and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.,Division of Immunology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Isabella Kardys
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander P W M Maat
- Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michał Ciszek
- Division of Immunology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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Guzik B, Szczepanek E, Niewiara Ł, Nosal M, Wierzbicki K, Krzanowski M, Szolc P, Kapelak B, Żmudka KF. Coronary revascularization after heart transplant - the search for prognostic factors. Arch Med Sci 2020; 16:789-795. [PMID: 32542079 PMCID: PMC7286336 DOI: 10.5114/aoms.2017.71847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/08/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Survival after heart transplantation (HTX) is extended due to continuous improvement of medical care, allowing enough time for coronary artery vasculopathy to develop. Data on the clinical outcome of cardiac transplantation patients after percutaneous coronary intervention (PCI) are still not extensively explored. The aim of our study was to assess whether heart transplantation itself compromises the outcome in patients undergoing percutaneous coronary intervention and to assess survival rates as well as major cardiovascular complications in heart transplant recipients who had undergone PCI. MATERIAL AND METHODS Thirty-three heart transplant recipients who had undergone PCI in the years 2005 to 2015 in a single center were matched by age, sex and main risk factors of arteriosclerosis with 33 controls without heart transplant history. Mean age of patients was 54.6 ±11.4 years in the HTX group and 58.8 ±10.8 years in controls. Median time from heart transplant to PCI was 13 years (4.4-22 years). Case and control groups did not differ in terms of standard risk factors of coronary artery disease, apart from chronic kidney disease, which was present in 70% of patients after heart transplantation, and dyslipidemia, which was present in 91% of control subjects. RESULTS Patients after HTX had worse survival compared to controls (p = 0.04). When adjusted for comorbidities in the Cox regression model, there was no significant difference in survival between cardiac transplant recipients and the control group (HR = 1.06; 95% CI: 0.10-11.24). Chronic renal disease was a significant predictor of all-cause mortality (HR = 29.9; 95% CI: 2.3-393). Considering other endpoints, HTX patients had considerably higher incidence of severe bleeding compared to the control group (27% vs. 3%, p < 0.05). CONCLUSIONS There was no significant difference in myocardial infarction rate, revascularization or hospitalization rates.
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Affiliation(s)
- Bartlomiej Guzik
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- Corresponding author: Bartlomiej Guzik, Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 80 Prądnicka St, 31-202 Krakow, Poland, E-mail:
| | - Elżbieta Szczepanek
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Łukasz Niewiara
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Marcin Nosal
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Karol Wierzbicki
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Marcin Krzanowski
- Department of Nephrology, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Szolc
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Bogusław Kapelak
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Krzysztof F. Żmudka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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18
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Taiwo AA, Khush KK, Stedman MR, Zheng Y, Tan JC. Longitudinal changes in kidney function following heart transplantation: Stanford experience. Clin Transplant 2018; 32:e13414. [PMID: 30240515 PMCID: PMC6265058 DOI: 10.1111/ctr.13414] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/08/2018] [Accepted: 09/13/2018] [Indexed: 11/30/2022]
Abstract
Many heart transplant recipients experience declining kidney function following transplantation. We aimed to quantify change in kidney function in heart transplant recipients stratified by pre-transplant kidney function. A total of 230 adult heart transplant recipients between May 1, 2008, and December 31, 2014, were evaluated for up to 5 years post-transplant (median 1 year). Using 19 398 total estimated glomerular filtration rate (eGFR) assessments, we evaluated trends in eGFR in recipients with normal/near-normal (eGFR ≥45 mL/min/1.73 m2 ) vs impaired (eGFR <45 mL/min/1.73 m2 ) kidney function and the likelihood of reaching an eGFR of 20 mL/min/1.73 m2 after heart transplant. Baseline characteristics were similar. Immediately following heart transplant, the impaired pre-transplant kidney function group showed a mean eGFR gain of 9.5 mL/min/1.73 m2 (n = 193) vs a mean decline of 4.9 mL/min/1.73 m2 (n = 37) in the normal/near-normal group. Subsequent rates of eGFR decline were 2.2 mL/min/1.73 m2 /y vs 2.9 mL/min/1.73 m2 /y, respectively. The probability of reaching an eGFR of 20 mL/min/1.73 m2 or less at 1, 5, and 10 years following heart transplant was 1%, 4%, and 30% in the impaired group, and <1%, <1%, and 10% in the normal/near-normal group. Estimates of expected recovery in kidney function and its decline over time will help inform decision making about kidney care after heart transplantation.
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Affiliation(s)
- Adetokunbo A Taiwo
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford Hospital & Clinics, Palo Alto, California
| | - Margaret R Stedman
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
| | - Yuanchao Zheng
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
| | - Jane C Tan
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
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19
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Influence of Blood Pressure and Calcineurin Inhibitors on Kidney Function After Heart or Liver Transplantation. Transplantation 2018; 102:845-852. [DOI: 10.1097/tp.0000000000002023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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20
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Reichart D, Reichenspurner H, Barten MJ. Renal protection strategies after heart transplantation. Clin Transplant 2018; 32. [DOI: 10.1111/ctr.13157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Daniel Reichart
- Department of Cardiovascular Surgery; , University Heart Center Hamburg; Hamburg Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery; , University Heart Center Hamburg; Hamburg Germany
| | - Markus Johannes Barten
- Department of Cardiovascular Surgery; , University Heart Center Hamburg; Hamburg Germany
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21
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Fortrie G, Manintveld OC, Constantinescu AA, van de Woestijne PC, Betjes MGH. Renal function at 1 year after cardiac transplantation rather than acute kidney injury is highly associated with long-term patient survival and loss of renal function - a retrospective cohort study. Transpl Int 2017; 30:788-798. [DOI: 10.1111/tri.12940] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/18/2016] [Accepted: 02/14/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Gijs Fortrie
- Division of Nephrology and Transplantation; Department of Internal Medicine; Erasmus MC; Rotterdam The Netherlands
| | | | | | | | - Michiel G. H. Betjes
- Division of Nephrology and Transplantation; Department of Internal Medicine; Erasmus MC; Rotterdam The Netherlands
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22
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McCartney SL, Patel C, Del Rio JM. Long-term outcomes and management of the heart transplant recipient. Best Pract Res Clin Anaesthesiol 2017; 31:237-248. [PMID: 29110796 DOI: 10.1016/j.bpa.2017.06.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/01/2017] [Accepted: 06/16/2017] [Indexed: 01/02/2023]
Abstract
Cardiac transplantation remains the gold standard in the treatment of advanced heart failure. With advances in immunosuppression, long-term outcomes continue to improve despite older and higher risk recipients. The median survival of the adult after heart transplantation is currently 10.7 years. While early graft failure and multiorgan system dysfunction are the most important causes of early mortality, malignancy, rejection, infection, and cardiac allograft vasculopathy contribute to late mortality. Chronic renal dysfunction is common after heart transplantation and occurs in up to 68% of patients by year 10, with 6.2% of patients requiring dialysis and 3.7% undergoing renal transplant. Functional outcomes after heart transplantation remain an area for improvement, with only 26% of patients working at 1-year post-transplantation, and are likely related to the high incidence of depression after cardiac transplantation. Areas of future research include understanding and managing primary graft dysfunction and reducing immunosuppression-related complications.
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Affiliation(s)
- Sharon L McCartney
- Divisions of Cardiothoracic and Critical Care Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
| | - Chetan Patel
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.
| | - J Mauricio Del Rio
- Divisions of Cardiothoracic and Critical Care Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
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23
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Perrault LP, Carrier M. Kidney transplantation as a therapeutic option for end-stage renal disease long after heart transplantation: Should we all do it? J Heart Lung Transplant 2017; 36:378-379. [PMID: 28325435 DOI: 10.1016/j.healun.2017.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Louis P Perrault
- Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
| | - Michel Carrier
- Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
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24
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Grupper A, Nativi-Nicolau J, Maleszewski JJ, Geske JR, Kremers WK, Edwards BS, Kushwaha SS, Pereira NL. Circulating Galectin-3 Levels Are Persistently Elevated After Heart Transplantation and Are Associated With Renal Dysfunction. JACC-HEART FAILURE 2016; 4:847-856. [PMID: 27614937 DOI: 10.1016/j.jchf.2016.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES This study evaluated changes in serum levels of galectin (Gal)-3 before and after heart transplantation (HTx) and assessed the role of pre-HTx Gal-3 as a biomarker for post-HTx outcomes. BACKGROUND Gal-3 is a novel biomarker that reflects cardiac remodeling and fibrosis. Elevated serum Gal-3 levels are associated with poor prognosis in heart failure patients. Whether Gal-3 levels change following HTx and the significance of post-HTx outcomes are unknown. METHODS Serum Gal-3 levels were measured in 62 patients at 118 days (Interquartile Range [IQR]: 23 to 798 days) before and 365 days (IQR: 54 to 767 days) post HTx. Cardiac tissue taken during routine post-HTx endomyocardial biopsy was evaluated to assess the correlation between tissue Gal-3 staining and serum Gal-3 levels and with the presence of myocardial hypertrophy and fibrosis. RESULTS Serum Gal-3 levels remained significantly elevated (>17.8 ng/ml) in 35 patients (56%) post HTx. There was a significant inverse correlation between Gal-3 levels and glomerular filtration rate measured before and after HTx (p > 0.005). There was no association between Gal-3 serum level and Gal-3 staining of myocardial tissue or with the presence of myocyte hypertrophy and interstitial fibrosis post HTx. Elevated pre-HTx Gal-3 levels were associated with reduced post-HTx exercise capacity, but this association was not significant after adjustment for age, body mass index, and glomerular filtration rate. CONCLUSIONS This is the first study to demonstrate the fact that Gal-3 levels remain elevated in the majority of patients despite HTx and is associated with renal dysfunction. Our findings suggest Gal-3 is a systemic rather than cardiac-specific biomarker.
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Affiliation(s)
- Avishay Grupper
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Joseph J Maleszewski
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer R Geske
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Walter K Kremers
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Brooks S Edwards
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Sudhir S Kushwaha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Naveen L Pereira
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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25
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Cardiac Rehabilitation After Complex Procedures. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Grupper A, Grupper A, Daly RC, Pereira NL, Hathcock MA, Kremers WK, Cosio FG, Edwards BS, Kushwaha SS. Kidney transplantation as a therapeutic option for end-stage renal disease developing after heart transplantation. J Heart Lung Transplant 2016; 36:297-304. [PMID: 27642059 DOI: 10.1016/j.healun.2016.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/25/2016] [Accepted: 08/10/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Progressive renal failure is a frequent complication after heart transplantation (HTx). It may result in end-stage renal disease (ESRD), prompting consideration of kidney Tx after HTx (KAH). METHODS We performed a retrospective single-center study of 268 HTx recipients to evaluate outcomes after KAH compared with HTx recipients with and without ESRD. RESULTS During a median follow-up of 76 months, ESRD developed in 51 patients (19), and 39 of them (76%) underwent KAH. The mean time from HTx to ESRD was 83 months. The incidence of switching to a calcineurin inhibitor (CNI)-free regimen based on sirolimus was significantly lower among recipients with ESRD (6% vs 57%, p = 0.0001), and prolonged exposure to CNI significantly increased the risk for ESRD (hazard ratio, 1.09; 95% confidence interval, 1.03-1.15; p < 0.005). Death-censored renal graft survival after KAH was 95%, 95%, and 83% at 1, 5, and 10 years, respectively. Median long-term survival of KAH patients was comparable to HTx recipients without ESRD (17.5 vs 17.1 years, p = 0.27) and significantly better compared with HTx recipients with ESRD (17.5 vs 7.3 years, p < 0.001). CONCLUSIONS Prolonged exposure to CNI immunosuppression medications significantly increases the risk for ESRD among HTx recipients. KAH is a good therapeutic option for HTx recipients with ESRD, with survival benefit comparable to HTx without ESRD.
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Affiliation(s)
- Avishay Grupper
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota
| | - Ayelet Grupper
- William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota; Divisions of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Richard C Daly
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Naveen L Pereira
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota
| | - Matthew A Hathcock
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Walter K Kremers
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Fernando G Cosio
- William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota; Divisions of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Brooks S Edwards
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota
| | - Sudhir S Kushwaha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota.
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Jalowiec A, Grady KL, White-Williams C. Clinical outcomes in overweight heart transplant recipients. Heart Lung 2016; 45:298-304. [PMID: 27086571 PMCID: PMC4935635 DOI: 10.1016/j.hrtlng.2016.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/28/2016] [Accepted: 03/03/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few studies have examined the impact of patient weight on heart transplant (HT) outcomes. OBJECTIVES Nine outcomes were compared in 2 groups of HT recipients (N = 347) based on their mean body mass index (BMI) during the first 3 years post-HT. METHODS Group 1 consisted of 108 non-overweight patients (BMI <25; mean age 52; 29.6% females; 16.7% minorities). Group 2 consisted of 239 overweight patients (BMI ≥25; mean age 52; 15.9% females; 13.8% minorities). Outcomes were: survival, re-hospitalization, rejections, infections, cardiac allograft vasculopathy (CAV), stroke, renal dysfunction, diabetes, and lymphoma. RESULTS Non-overweight patients had shorter survival, were re-hospitalized more days after the HT discharge, and had more lymphoma and severe renal dysfunction. Overweight patients had more CAV, steroid-induced diabetes, and acute rejections. CONCLUSIONS Overweight HT patients had better survival, but more rejections, CAV, and diabetes. Non-overweight HT patients had worse survival, plus more re-hospitalization time, lymphoma, and renal dysfunction.
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Affiliation(s)
- Anne Jalowiec
- School of Nursing, Loyola University of Chicago, Chicago, IL, USA.
| | - Kathleen L Grady
- Center for Heart Failure, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern Memorial Hospital, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Connie White-Williams
- Center for Nursing Excellence, University of Alabama at Birmingham Hospital, Birmingham, AL, USA; University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
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Söderlund C, Löfdahl E, Nilsson J, Reitan Ö, Higgins T, Rådegran G. Chronic kidney disease after heart transplantation: a single-centre retrospective study at Skåne University Hospital in Lund 1988-2010. Transpl Int 2016; 29:529-39. [DOI: 10.1111/tri.12710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/15/2015] [Accepted: 10/27/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Carl Söderlund
- Department of Clinical Sciences Lund; Cardiology; Lund University; Lund Sweden
- The Haemodynamic Lab; The Section for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
| | - Eveline Löfdahl
- Department of Clinical Sciences Lund; Cardiology; Lund University; Lund Sweden
- The Haemodynamic Lab; The Section for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
| | - Johan Nilsson
- Department of Clinical Sciences Lund; Cardiothoracic Surgery; Lund University and Skåne University Hospital; Lund Sweden
| | - Öyvind Reitan
- Department of Clinical Sciences Lund; Cardiology; Lund University; Lund Sweden
- The Haemodynamic Lab; The Section for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
| | - Thomas Higgins
- Children's Heart Centre and Pediatric Surgery; Skåne University Hospital; Lund Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund; Cardiology; Lund University; Lund Sweden
- The Haemodynamic Lab; The Section for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
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Kim DH, Eisen HJ. Novel, More Accurate Assessments of Renal Function in Heart Transplant Patients [corrected]. Transpl Int 2015; 29:527-8. [PMID: 26643198 DOI: 10.1111/tri.12729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 11/27/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Diana H Kim
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Howard J Eisen
- Drexel University College of Medicine, Philadelphia, PA, USA
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Tam N, Zhang C, Lin J, Wu C, Deng R, Liao B, Hu S, Wang D, Zhu X, Wu L, He X. Simultaneous pancreas and kidney transplantation for liver transplant recipients with diabetes and uremia. Clin Res Hepatol Gastroenterol 2015; 39:399-404. [PMID: 25457347 DOI: 10.1016/j.clinre.2014.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/07/2014] [Accepted: 10/09/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) has become a critical problem due to immunosuppressant related nephrotoxicity in liver transplant (LTx) recipients, especially in patients with pre-transplant risk factors. LTx recipients with uraemia and diabetes have poor prognosis even when treated with dialysis and insulin. Simultaneous pancreas and kidney transplantation (SPK) has been proven to be an effective treatment for patients with diabetic uraemia, but rarely performed in patients after LTx. Two cases of SPK after LTx were performed in our centre and we present our experience here. PATIENTS AND METHODS Two patients received LTx because of HBV related liver cirrhosis; both of them had pre-transplant diabetes mellitus (DM), which worsened after the administration of immunosuppressive drugs. These two patients suffered from CKD and developed uraemia due to diabetic nephropathy and immunosuppressive drugs induced renal toxicity years after LTx. They relied on dialysis and insulin injection. SPK were performed years after LTx and the clinical data was retrospectively analyzed. RESULTS SPK was successfully performed in these two patients. Pancreatic fluid drainage was achieved via a side-to-side duodenojejunostomy into the proximal jejunum. No serious surgical complications, including pancreatitis or pancreatic fistula were observed postoperatively. In both cases, kidney and pancreatic grafts were functioning well as evidenced by euglycemia without the need for insulin injections and normal serum-creatinine level 7days after the operation. One of the patients presented with renal graft impairment 1week after the operation. FK506 was tapered and rapamycin was used when the renal graft biopsy indicated drug toxicity. The patient's kidney graft function recovered gradually after the adjustment. Both patients have good function of liver, kidney and pancreas grafts during a 60-month and 30-month period of follow up. CONCLUSIONS SPK could serve as an effective option for patients with diabetes and uremia after LTx. Perioperative management, especially the immunosuppressive strategy is crucial to improve the outcome of this procedure.
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Affiliation(s)
- Ngalei Tam
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Hepatobiliary surgery department, the University of Hong Kong, Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Chuanzhao Zhang
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jianwei Lin
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chenglin Wu
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ronghai Deng
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bing Liao
- Pathology Department, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shuiqing Hu
- Department of Clinical Laboratories, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Dongping Wang
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaofeng Zhu
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Linwei Wu
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Xiaoshun He
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Sponga S, Montanaro D, Livi U. Heart re-transplantation combined with kidney transplantation. Transpl Int 2015; 28:1231-2. [DOI: 10.1111/tri.12598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sandro Sponga
- Cardiothoracic Department; University Hospital of Udine; Udine Italy
| | | | - Ugolino Livi
- Cardiothoracic Department; University Hospital of Udine; Udine Italy
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Andreassen AK, Andersson B, Gustafsson F, Eiskjaer H, Radegran G, Gude E, Jansson K, Solbu D, Sigurdardottir V, Arora S, Dellgren G, Gullestad L. Everolimus initiation and early calcineurin inhibitor withdrawal in heart transplant recipients: a randomized trial. Am J Transplant 2014; 14:1828-38. [PMID: 25041227 DOI: 10.1111/ajt.12809] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 01/25/2023]
Abstract
In a randomized, open-label trial, everolimus was compared to cyclosporine in 115 de novo heart transplant recipients. Patients were assigned within 5 days posttransplant to low-exposure everolimus (3–6 ng/mL) with reduced-exposure cyclosporine (n = 56), or standard-exposure cyclosporine (n = 59), with both mycophenolate mofetil and corticosteroids. In the everolimus group, cyclosporine was withdrawn after 7–11 weeks and everolimus exposure increased (6–10 ng/mL). The primary efficacy end point, measured GFR at 12 months posttransplant, was significantly higher with everolimus versus cyclosporine (mean ± SD: 79.8 ± 17.7 mL/min/1.73 m2 vs. 61.5 ± 19.6 mL/min/1.73 m2; p < 0.001). Coronary intravascular ultrasound showed that the mean increase in maximal intimal thickness was smaller (0.03 mm [95% CI 0.01, 0.05 mm] vs. 0.08 mm [95% CI 0.05, 0.12 mm], p = 0.03), and the incidence of cardiac allograft vasculopathy (CAV) was lower (50.0% vs. 64.6%, p = 0.003), with everolimus versus cyclosporine at month 12. Biopsy-proven acute rejection after weeks 7–11 was more frequent with everolimus (p = 0.03). Left ventricular function was not inferior with everolimus versus cyclosporine. Cytomegalovirus infection was less common with everolimus (5.4% vs. 30.5%, p < 0.001); the incidence of bacterial infection was similar. In conclusion, everolimus-based immunosuppression with early elimination of cyclosporine markedly improved renal function after heart transplantation. Since postoperative safety was not jeopardized and development of CAV was attenuated, this strategy may benefit long-term outcome.
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DePasquale EC, Schweiger M, Ross HJ. A contemporary review of adult heart transplantation: 2012 to 2013. J Heart Lung Transplant 2014; 33:775-84. [DOI: 10.1016/j.healun.2014.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/14/2014] [Accepted: 04/30/2014] [Indexed: 02/07/2023] Open
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Janus N, Launay-Vacher V, Sebbag L, Despins P, Epailly E, Pavie A, Obadia JF, Pattier S, Varnous S, Pezzella V, Trillaud L, Deray G, Guillemain R. Renal insufficiency, mortality, and drug management in heart transplant. Results of the CARIN study. Transpl Int 2014; 27:931-8. [DOI: 10.1111/tri.12359] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/12/2013] [Accepted: 05/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Nicolas Janus
- Service ICAR; Nephrology Department; Pitie-Salpetriere Hospital; Paris France
| | | | - Laurent Sebbag
- Heart Transplant Department; Louis Pradel Cardiology Hospital; Lyon France
| | - Philippe Despins
- Thoracic Transplant Department; North Hospital CHU Nantes; Nantes France
| | - Eric Epailly
- Cardiac Surgery Department; Nouvel Hôpital Civil; Strasbourg France
| | - Alain Pavie
- Thorac and Cardiovasculars Surgery Department; Pitie-Salpetriere Hospital; Paris France
| | | | - Sabine Pattier
- Thoracic Transplant Department; North Hospital CHU Nantes; Nantes France
| | - Shaïda Varnous
- Thorac and Cardiovasculars Surgery Department; Pitie-Salpetriere Hospital; Paris France
| | - Veronica Pezzella
- Thoracic Transplant Department; Georges Pompidou European Hospital; Paris France
| | - Laurence Trillaud
- Service ICAR; Nephrology Department; Pitie-Salpetriere Hospital; Paris France
| | - Gilbert Deray
- Nephrology Department; Pitie-Salpetriere Hospital; Paris France
| | - Romain Guillemain
- Thoracic Transplant Department; Georges Pompidou European Hospital; Paris France
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Lachance K, White M, Carrier M, Mansour A, Racine N, Liszkowski M, Ducharme A, de Denus S. Long-term evolution, secular trends, and risk factors of renal dysfunction following cardiac transplantation. Transpl Int 2014; 27:824-37. [DOI: 10.1111/tri.12340] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/03/2014] [Accepted: 04/13/2014] [Indexed: 01/20/2023]
Affiliation(s)
- Kim Lachance
- Montreal Heart Institute; Montreal QC Canada
- Faculty of Pharmacy; Université de Montréal; Montreal QC Canada
| | - Michel White
- Montreal Heart Institute; Montreal QC Canada
- Faculty of Medicine; Université de Montréal; Montreal QC Canada
| | - Michel Carrier
- Montreal Heart Institute; Montreal QC Canada
- Faculty of Medicine; Université de Montréal; Montreal QC Canada
| | - Asmaa Mansour
- Montreal Health Innovations Coordinating Center; a Division of the Montreal Heart Institute; Montreal QC Canada
| | - Normand Racine
- Montreal Heart Institute; Montreal QC Canada
- Faculty of Medicine; Université de Montréal; Montreal QC Canada
| | - Mark Liszkowski
- Montreal Heart Institute; Montreal QC Canada
- Faculty of Medicine; Université de Montréal; Montreal QC Canada
| | - Anique Ducharme
- Montreal Heart Institute; Montreal QC Canada
- Faculty of Medicine; Université de Montréal; Montreal QC Canada
| | - Simon de Denus
- Montreal Heart Institute; Montreal QC Canada
- Faculty of Pharmacy; Université de Montréal; Montreal QC Canada
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