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Chaemchoi T, Ittiwattanakul W, Ritteeverakul P, Intrarakamhang AL, Thammanatsakul K, Sinphurmsukskul S, Siwamogsatham S, Puwanant S, Ariyachaipanich A. The decline in kidney function after heart transplantation and its impact on survival. Clin Transplant 2023; 37:e15112. [PMID: 37676472 DOI: 10.1111/ctr.15112] [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: 07/03/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Evidence of decline in native renal function after heart transplantation (HTx) in the Asian population is limited. This study determined the incidence and risk factors associated with declining kidney function after HTx and its impact on survival. METHODS A retrospective study of consecutive adult heart transplant patients was conducted in a single center between 2010 and 2020. The decline in kidney function was defined as the presence of one of the following criteria, including a ≥ 40% decline in eGFR, absolute value <15 mL/min/1.73 m2 (calculated by the CKD-EPI method), doubling of serum creatinine, or dialysis. RESULTS A total of 79 patients (77% male, mean age 44.5 ± 11.53 years, with a mean eGFR at discharge from the heart transplant admission of 87.9 ± 25.48 mL/min/1.73 m2 ) were included. During the median follow-up of 42 months, the rate of decline in eGFR was 3.9 mL/min/1.73 m2 per year, with a cumulative probability of decline in kidney function of 22% at 1 year and 43% at 5 years. The need for dialysis was 2.5% at 1 year and 5% at 5 years. The decline in kidney function within 1 year after discharge (hazard ratio (HR), 22.24; p = .007) and pre-HTx diabetes mellitus (DM) (HR, 8.99; p = .034) were independently associated with the need for dialysis. Post-HTx dialysis predicted all-cause mortality (HR, 4.47; p = .017). CONCLUSIONS Approximately 20% of HTx patients developed a decline in kidney function within 1 year after discharge. These individuals and pre-HTx DM patients needed preventive measures to prevent progression to chronic dialysis, which impacted survival. (thaiclinicaltrials.org number, TCTR20230620004).
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Affiliation(s)
- Tasigan Chaemchoi
- Department of Pharmacy, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Wannee Ittiwattanakul
- Department of Pharmacy, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Puangpen Ritteeverakul
- Department of Pharmacy, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Ai-Lada Intrarakamhang
- Excellent Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Kanokwan Thammanatsakul
- Excellent Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Supanee Sinphurmsukskul
- Excellent Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Sarawut Siwamogsatham
- Chula Clinical Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sarinya Puwanant
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Aekarach Ariyachaipanich
- Excellent Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Khan MS, Ahmed A, Greene SJ, Fiuzat M, Kittleson MM, Butler J, Bakris GL, Fonarow GC. Managing Heart Failure in Patients on Dialysis: State-of-the-Art Review. J Card Fail 2023; 29:87-107. [PMID: 36243339 DOI: 10.1016/j.cardfail.2022.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/28/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
Heart failure (HF) and end-stage kidney disease (ESKD) frequently coexist; 1 comorbidity worsens the prognosis of the other. HF is responsible for almost half the deaths of patients on dialysis. Despite patients' with ESKD composing an extremely high-risk population, they have been largely excluded from landmark clinical trials of HF, and there is, thus, a paucity of data regarding the management of HF in patients on dialysis, and most of the available evidence is observational. Likewise, in clinical practice, guideline-directed medical therapy for HF is often down-titrated or discontinued in patients with ESKD who are undergoing dialysis; this is due to concerns about safety and tolerability. In this state-of-the-art review, we discuss the available evidence for each of the foundational HF therapies in ESKD, review current challenges and barriers to managing patients with HF on dialysis, and outline future directions to optimize the management of HF in these high-risk patients.
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Affiliation(s)
| | - Aymen Ahmed
- Division of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - Mona Fiuzat
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute-Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Baylor Scott and White Research Institute, Dallas, TX, USA
| | - George L Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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3
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Swanson KJ. Kidney disease in non-kidney solid organ transplantation. World J Transplant 2022; 12:231-249. [PMID: 36159075 PMCID: PMC9453292 DOI: 10.5500/wjt.v12.i8.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/07/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
Kidney disease after non-kidney solid organ transplantation (NKSOT) is a common post-transplant complication associated with deleterious outcomes. Kidney disease, both acute kidney injury and chronic kidney disease (CKD) alike, emanates from multifactorial, summative pre-, peri- and post-transplant events. Several factors leading to kidney disease are shared amongst solid organ transplantation in addition to distinct mechanisms unique to individual transplant types. The aim of this review is to summarize the current literature describing kidney disease in NKSOT. We conducted a narrative review of pertinent studies on the subject, limiting our search to full text studies in the English language. Kidney disease after NKSOT is prevalent, particularly in intestinal and lung transplantation. Management strategies in the peri-operative and post-transplant periods including proteinuria management, calcineurin-inhibitor minimization/ sparing approaches, and nephrology referral can counteract CKD progression and/or aid in subsequent kidney after solid organ transplantation. Kidney disease after NKSOT is an important consideration in organ allocation practices, ethics of transplantation. Kidney disease after SOT is an incipient condition demanding further inquiry. While some truths have been revealed about this chronic disease, as we have aimed to describe in this review, continued multidisciplinary efforts are needed more than ever to combat this threat to patient and allograft survival.
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Affiliation(s)
- Kurtis J Swanson
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN 55414, United States
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4
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Mete M, Ayvaci MU, Ariyamuthu VK, Amin A, Peltz M, Thibodeau JT, Grodin JL, Mammen PP, Garg S, Araj F, Morlend R, Drazner MH, AbdulRahim N, Kim Y, Salam Y, Gungor AB, Delibasi B, Kotla SK, MacConmara MP, Mohan P, Gupta G, Tanriover B. Predicting Post-Heart Transplant Composite Renal Outcome Risk in Adults: A Machine Learning Decision Tool. Kidney Int Rep 2022; 7:1410-1415. [PMID: 35685329 PMCID: PMC9171705 DOI: 10.1016/j.ekir.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 12/02/2022] Open
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5
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Miklin DJ, Mendoza M, DePasquale EC. Two is better than one: when to consider multiorgan transplant. Curr Opin Organ Transplant 2022; 27:86-91. [PMID: 34890379 DOI: 10.1097/mot.0000000000000951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Patients with end-stage heart failure often present with concomitant end-stage renal or end-stage liver disease requiring transplantation. There are limited data regarding the risks, benefits and long-term outcomes of heart-kidney (HKT) and heart-liver transplantation (HLT), and guidelines are mainly limited to expert consensus statements. RECENT FINDINGS The incidence of HKT and HLT has steadily increased in recent years with favourable outcomes. Both single-centre and large database studies have shown benefits of HKT/HLT through improved survival, freedom from dialysis and lower rates of rejection and coronary allograft vasculopathy. Current guidelines are institution dependent and controversial due to the ethical considerations surrounding multiorgan transplantation (MOT). SUMMARY MOT is an effective and necessary option for patients with end-stage heart and kidney/liver failure. MOT is ethically permissible, and efforts should be made to consider eligible patients as early as possible to limit morbidity and mortality. Further research is needed regarding appropriate listing criteria and long-term outcomes.
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Affiliation(s)
| | - Matthew Mendoza
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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6
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Shaw BI, Sudan DL, Boulware LE, McElroy LM. Striking a Balance in Simultaneous Heart Kidney Transplant: Optimizing Outcomes for All Wait-Listed Patients. J Am Soc Nephrol 2020; 31:1661-1664. [PMID: 32499397 DOI: 10.1681/asn.2020030336] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Brian I Shaw
- Department of Surgery, Duke Transplant Center, Duke University, Durham, North Carolina
| | - Debra L Sudan
- Department of Surgery, Duke Transplant Center, Duke University, Durham, North Carolina
| | - L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Lisa M McElroy
- Department of Surgery, Duke Transplant Center, Duke University, Durham, North Carolina
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7
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Barten MJ, Hirt SW, Garbade J, Bara C, Doesch AO, Knosalla C, Grinninger C, Stypmann J, Sieder C, Lehmkuhl HB, Porstner M, Schulz U. Comparing everolimus-based immunosuppression with reduction or withdrawal of calcineurin inhibitor reduction from six months after heart transplantation: the randomized MANDELA study. Am J Transplant 2019; 19:S1600-6135(22)09293-0. [PMID: 30884079 DOI: 10.1111/ajt.15361] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the 12-month, open-label MANDELA study, patients were randomized at month 6 after heart transplantation to (i) convert to calcineurin inhibitor (CNI)-free immunosuppression with everolimus (EVR), mycophenolic acid and steroids (CNI-free, n=71), or to (ii) continue reduced-exposure CNI, with EVR and steroids (EVR/redCNI, n=74). Tacrolimus was administered in 48.8% of EVR/redCNI patients and 52.6% of CNI-free patients at radomization. Both strategies improved and stabilized renal function based on the primary endpoint (estimated GFR at month 18 post-transplant post-randomization) with superiority of the CNI-free group versus EVR/redCNI : mean 64.1mL/min/1.73m2 versus 52.9mL/min/1.73m2 ; difference +11.3mL/min/1.73m2 (p<0.001). By month 18, estimated GFR had increased by ≥10mL/min/1.732 in 31.8% and 55.2% of EVR/redCNI and CNI-free patients, respectively, and by ≥25 mL/min/1.73m2 in 4.5% and 20.9%. Rates of biopsy-proven acute rejection (BPAR) were 6.8% and 21.1%; all cases were without hemodynamic compromise. BPAR was less frequent with EVR/redCNI versus the CNI-free regimen (p=0.015); 6/15 episodes in CNI-free patients occurred with EVR concentration <5ng/mL. Rates of adverse events and associated discontinuations were comparable EVR/redCNI from month 6 achieved stable renal function with infrequent BPAR. One-year renal function can be improved by early conversion to EVR-based CNI-free therapy but requires close EVR monitoring. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Markus J Barten
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Stephan W Hirt
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Jens Garbade
- University Department of Cardiac Surgery, Leipzig Heart Center, Strümpellstraße 39 Leipzig, Germany
| | - Christoph Bara
- Division of Cardiovascular, Thoracic and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Andreas O Doesch
- Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Carola Grinninger
- Department of Cardiac Surgery, Munich Transplantation Center, Klinikum Großhadern LMU, Marchioninistraße 15, 81377, Munich, Germany
| | - Jörg Stypmann
- Department of Cardiovascular Medicine, Division of Cardiology, University Hospital Münster, Albert-Schweitzer-Straße 33, 48149, Münster, Germany
| | | | - Han B Lehmkuhl
- University Department of Cardiac Surgery, Leipzig Heart Center, Strümpellstraße 39 Leipzig, Germany
| | | | - Uwe Schulz
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
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8
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Asleh R, Snipelisky D, Hathcock M, Kremers W, Liu D, Batzler A, Jenkins G, Kushwaha S, Pereira NL. Genomewide association study reveals novel genetic loci associated with change in renal function in heart transplant recipients. Clin Transplant 2018; 32:e13395. [PMID: 30160337 DOI: 10.1111/ctr.13395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/13/2018] [Accepted: 08/23/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Renal dysfunction occurs commonly after heart transplantation (HTx) with wide inter-individual variability but whether a genetic predisposition exists in these patients is unknown. Genomewide association studies (GWAS) have not been performed to assess the association of genetic variation with change in renal function after HTx. METHODS Clinical and demographic data of patients who underwent HTx and provided blood samples and consent for genetic analysis were included. Genotyping was performed using Illumina Infinium Human CoreExome v1.0 analysis kit. A GWAS utilizing linear regression models was performed with estimated glomerular filtration rate (eGFR) at 1 year as the phenotype after adjusting for baseline eGFR prior to HTx and conversion from calcineurin inhibitor to sirolimus as primary immunosuppression therapy. RESULTS A total of 251 HTx recipients were genotyped for 314,903 single nucleotide polymorphisms (SNPs). The mean (SD) age was 50 (12.5) years; most patients were of European origin (n = 243, 96.8%) and males (n = 179, 71.3%). After adjustment for potential confounders, two variants, rs17033285 (P = 4.3 × 10-7 ) and rs4917601 (P = 6.46 × 10-7 ), in a long non-coding RNA (lncRNA) gene LINC01121 and a pseudogene BTBD7P2, were identified to have a significant association with change in GFR at 1 year after HTx. CONCLUSIONS Our first of its kind GWAS demonstrates that genetic variation affects renal function after HTx independent of other risk factors. Agnostic genetic approaches such as these may lead to identification of novel biological pathways such as the role of lncRNAs in the development of renal dysfunction post-HTx.
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Affiliation(s)
- Rabea Asleh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David Snipelisky
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Hathcock
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Walter Kremers
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Duan Liu
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Anthony Batzler
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Gregory Jenkins
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Sudhir Kushwaha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Naveen L Pereira
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
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9
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Renal function and outcome after heart transplantation. J Thorac Cardiovasc Surg 2018; 155:1593-1604.e1. [DOI: 10.1016/j.jtcvs.2017.11.087] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 11/09/2017] [Accepted: 11/26/2017] [Indexed: 12/21/2022]
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10
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Foroutan F, Alba AC, Guyatt G, Duero Posada J, Ng Fat Hing N, Arseneau E, Meade M, Hanna S, Badiwala M, Ross H. Predictors of 1-year mortality in heart transplant recipients: a systematic review and meta-analysis. Heart 2017; 104:151-160. [DOI: 10.1136/heartjnl-2017-311435] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/17/2017] [Accepted: 06/06/2017] [Indexed: 11/04/2022] Open
Abstract
ObjectiveA systematic summary of the observational studies informing heart transplant guideline recommendations for selection of candidates and donors has thus far been unavailable. We performed a meta-analysis to better understand the impact of such known risk factors.MethodsWe systematically searched and meta-analysed the association between known pretransplant factor and 1-year mortality identified by multivariable regression models. Our review used the Grading of Recommendations, Assessment, Development and Evaluation for assessing the quality of assessment. We pooled risk estimates by using random effects models.ResultsRecipient variables including age (HR 1.16 per 10-year increase, 95% CI 1.10–1.22, high quality), congenital aetiology (HR 2.35, 95% CI 1.62 to 3.41, moderate quality), diabetes (HR 1.37, 95% CI 1.15 to 1.62, high quality), creatinine (HR 1.11 per 1 mg/dL increase, 95% CI 1.06 to 1.16, high quality), mechanical ventilation (HR 2.46, 95% CI 1.48 to 4.09, low quality) and short-term mechanical circulatory support (MCS) (HR 2.47, 95% CI 1.04 to 5.87, low quality) were significantly associated with 1-year mortality. Donor age (HR 1.20 per 10-year increase, 95% CI 1.14 to 1.26, high quality) and female donor to male recipient sex mismatch (HR 1.38, 95% CI 1.06 to 1.80, high quality) were significantly associated with 1-year mortality. None of the operative factors proved significant predictors.ConclusionHigh-quality and moderate-quality evidence demonstrates that recipient age, congenital aetiology, creatinine, pulsatile MCS, donor age and female donor to male recipient sex mismatch are associated with 1-year mortality post heart transplant. The results of this study should inform future guideline and predictive model development.
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11
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Hong KN, Merlo A, Chauhan D, Davies RR, Iribarne A, Johnson E, Jeevanandam V, Russo MJ. Evidence supports severe renal insufficiency as a relative contraindication to heart transplantation. J Heart Lung Transplant 2016; 35:893-900. [DOI: 10.1016/j.healun.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 02/03/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022] Open
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12
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The importance of renal function for the management of the sick newborn with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2015.12.002] [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: 11/23/2022]
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13
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Gupta P, Rettiganti M, Gossett JM, Gardner M, Bryant JC, Noel TR, Knecht KR. Longitudinal renal function in pediatric heart transplant recipients: 20-years experience. Pediatr Transplant 2015; 19:182-7. [PMID: 25484128 DOI: 10.1111/petr.12409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 01/22/2023]
Abstract
This study was initiated to assess the temporal trends of renal function, and define risk factors associated with worsening renal function in pediatric heart transplant recipients in the immediate post-operative period. We performed a single-center retrospective study in children ≤18 yr receiving OHT (1993-2012). The AKIN's validated, three-tiered AKI staging system was used to categorize the degree of WRF. One hundred sixty-four patients qualified for inclusion. Forty-seven patients (28%) were classified as having WRF after OHT. Nineteen patients (11%) required dialysis after heart transplantation. There was a sustained and steady improvement in renal function in children following heart transplantation in all age groups, irrespective of underlying disease process. The significant factors associated with risk of WRF included body surface area (OR: 1.89 for 0.5 unit increase, 95% CI: 1.29-2.76, p = 0.001) and use of ECMO prior to and/or after heart transplantation (OR: 3.50, 95% CI: 1.51-8.13, p = 0.004). Use of VAD prior to heart transplantation was not associated with WRF (OR: 0.50, 95% CI: 0.17-1.51, p = 0.22). On the basis of these data, we demonstrate that worsening renal function improves early after orthotopic heart transplantation.
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Affiliation(s)
- Punkaj Gupta
- Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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14
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Knezevic I, Poglajen G, Hrovat E, Oman A, Pintar T, Wu JC, Vrtovec B, Haddad F. The effects of levosimendan on renal function early after heart transplantation: results from a pilot randomized trial. Clin Transplant 2014; 28:1105-11. [PMID: 25053182 DOI: 10.1111/ctr.12424] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND We evaluated the effects of a levosimendan (LS)-based strategy compared with standard inotropic therapy on renal function in heart transplantation. METHODS AND RESULTS Using a randomized study design, 94 patients were assigned to LS-based therapy or standard inotropic support. At the time of transplantation, the groups did not differ in age, gender, heart failure etiology, hemodynamic profile, LVEF, or comorbidities. While there were no differences in serum creatinine (sCr) or eGFR between groups at baseline, patients in the LS group had a greater increase in their relative eGFR (62% vs. 12%, p = 0.002) and a lower incidence of acute kidney injury (AKI) (28% vs. 6%, p = 0.01) during the first post-transplant week. On logistic regression analysis, correlates of AKI were randomization to LS therapy (OR = 0.21 [0.09-0.62], p = 0.01), baseline renal dysfunction (OR = 3.9 [1.1-13.6], p = 0.032), and diabetes mellitus (OR = 4.2 [1.1-16.5], p = 0.038). However, LS was associated with a greater need for additional norepinephrine therapy (40 [85%] vs. 15 [31%], p < 0.001) and a trend toward longer intensive care unit stay (9.5 ± 9.0 d vs. 7.0 ± 6.0 d, p = 0.13). CONCLUSIONS In patients undergoing heart transplantation, levosimendan-based strategy may be associated with better renal function when compared to standard therapy.
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Affiliation(s)
- Ivan Knezevic
- Advanced Heart Failure and Transplantation Center, UMC, Ljubljana, Slovenia
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15
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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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16
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Fantidis P, Sánchez E, Tarhini I, Khan I, Pineda T, Corrales JA, González JR. Left ventricular assist devices in patients with end-stage heart failure: suggestion of an alternative treatment based on clinically well-known concepts. Angiology 2014; 65:861-8. [PMID: 24482491 DOI: 10.1177/0003319713518838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Encouraging results were obtained by using left ventricular assist devices (LVADs) in patients with end-stage heart failure (HF) that exhibits extremely high mortality and who were not candidates for heart transplantation. By using this so-called destination therapy (DT), a substantial percentage of these patients achieved sufficient improvement in cardiac function to permit the explantation of the device. The combination of mechanical and pharmacological therapy increased the frequency and durability of myocardial recovery as compared with other therapeutic approaches. Although cardiac transplantation, LVADs, and cardiac resynchronization therapy have provided a major advance in DT, their limitations stimulate the search for alternative therapies. We discuss the limitations of these 3 treatment options for end-stage HF. Also, we propose and discuss the possible advantages of a new intracorporeal procedure that works continuously as intraaortic balloon counterpulsation without an extracorporeal or intracorporeal computer-controlled mechanism.
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Affiliation(s)
- Panayotis Fantidis
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - Eladio Sánchez
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - Ibrahim Tarhini
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - Ijaz Khan
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - Tomas Pineda
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - Juan Antonio Corrales
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - José Ramón González
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
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17
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Incidence, Determinants, and Outcome of Chronic Kidney Disease After Adult Heart Transplantation in the United Kingdom. Transplantation 2012; 93:1151-7. [DOI: 10.1097/tp.0b013e31824e7620] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Early changes in kidney function predict long-term chronic kidney disease and mortality in patients after liver transplantation. Transplantation 2012; 92:1358-63. [PMID: 22067311 DOI: 10.1097/tp.0b013e3182384aff] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a well-known complication after liver transplantation (LT) and is associated with increased mortality. The purpose of this study was to determine risk factors of advanced CKD and mortality after LT. METHODS Four hundred forty-five adult patients underwent LT between June 1990 and September 2007 and survived more than 1 month. Multivariate Cox regression analyses were performed for time to CKD stage 4 (glomerular filtration rate [GFR] ≤30 mL/min), time to chronic dialysis, and all-cause mortality. Several patient and disease characteristics were used as independent pre- and posttransplant variables. We specifically analyzed a drop more than or equal to 30% in the estimated GFR (eGFR) during the first year posttransplant. RESULTS Diabetes mellitus pretransplant and a drop more than or equal to 30% in the eGFR between 3 and 12 months predicted CKD stage 4 (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.9-5.4, P<0.001 and OR 16.1, 95% CI 5.9-44.5, P<0.0001, respectively), the need for chronic dialysis (OR 3.8, 95% CI 1.1-13.2, P=0.03 and OR 14.6, 95% CI 3.0-71.4, P<0.001, respectively), and all-cause mortality (OR 1.9, 95% CI 1.2-2.9, P=0.004 and OR 2.6, 95% CI 1.6-4.4, P<0.001, respectively), more than 1 year after LT. CONCLUSIONS Diabetes mellitus pretransplant and a drop more than or equal to 30% in the eGFR within the first year are strong predictors of advanced CKD, chronic dialysis, and death more than 1 year after LT. These easily determined clinical variables define a population at risk for CKD who should be targeted for renal protection strategies.
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19
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Karabsheh S, Verma DR, Jain M, Stoddard G, Brunisholz K, Stehlik J, Kfoury A, Gilbert E, Bader F. Clinical and hemodynamic effects of renin-angiotensin system blockade in cardiac transplant recipients. Am J Cardiol 2011; 108:1836-9. [PMID: 22133132 DOI: 10.1016/j.amjcard.2011.07.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 07/25/2011] [Accepted: 07/25/2011] [Indexed: 10/14/2022]
Abstract
Chronic kidney disease continues to be a major limiting factor for long-term survival of heart transplant recipients. Little is known about the early use of renin-angiotensin system (RAS) blocking agents and their impact on renal function and hemodynamics in heart transplant recipients. In this cohort study all eligible recipients of orthotopic heart transplants at the UTAH cardiac transplantation program from 2001 through 2007 were divided into 2 groups-patients who were started on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers within the first 4 weeks of transplantation and continued on these for ≥4 weeks during the first 3 months (RAS blockade group, n = 75) and those who were not (non-RAS blockade group, n = 52). All patients were followed for 1 year after transplantation. There were no significant differences at baseline between the 2 groups. Estimated glomerular filtration rate at 12 months was significantly higher in the RAS blockade group compared to the non-RAS blockade group (mean ± SD, 56.3 ± 22.4 vs 47.3 ± 18.1 ml/min/1.73 m(2), p = 0.036). At 12 months pulmonary artery systolic pressure was significantly lower in the RAS blockade group compared to the non-RAS blockade group (30.2 ± 7.4 vs 32.9 ± 9.3 mm Hg, p = 0.023). Left ventricular ejection fraction and pulmonary capillary wedge pressure were similar between the 2 groups. In conclusion, early RAS blockade after heart transplantation is safe, well tolerated, and associated with better renal function and hemodynamic profile at 1 year after transplantation.
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20
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Tang L, Du W, L'Ecuyer TJ. Perioperative renal failure in pediatric heart transplant recipients: outcome and risk factors. Pediatr Transplant 2011; 15:430-6. [PMID: 21585631 DOI: 10.1111/j.1399-3046.2010.01445.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PRF is encountered in 10-13% of adult heart transplants. Only one study of a single center's experience with PRF has been reported in pediatric patients. This study examines the effect of PRF on pediatric heart transplant outcome using the UNOS database. A total of 3598 patients met inclusion criteria, of whom 254 (7%) had PRF. The PRF group comprised 31 recipients requiring PRE and 223 recipients requiring POST. Compared with No-PRF patients, PRE patients had similar survival rate and POST patients had decreased survival rate at 30 days, one, five, and 10-yr post-transplant (p < 0.001). PRF patients also had significantly lower graft survival at one, five, and 10 yr (p < 0.001). Risk factors for developing PRF included ECMO, ventilator, and inotropic support at listing and CHD as the listing diagnosis. PRF increased the duration of hospital stay and the incidence of chronic severe renal dysfunction. PRF that requires POST (whether or not it began pretransplant) has a significant negative impact on pediatric heart transplant outcome. Specific characteristics identify patients at particular high risk of developing PRF.
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Affiliation(s)
- Liwen Tang
- Division of Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
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21
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Hornum M, Andersen M, Gustafsson F, Oturai P, Sander K, Mortensen S, Feldt-Rasmussen B. Rapid Decline in Glomerular Filtration Rate during the First Weeks Following Heart Transplantation. Transplant Proc 2011; 43:1904-7. [DOI: 10.1016/j.transproceed.2011.02.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 02/16/2011] [Indexed: 11/24/2022]
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22
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Singh M, Shullo M, Kormos RL, Lockard K, Zomak R, Simon MA, Bermudez C, Bhama J, McNamara D, Toyoda Y, Teuteberg JJ. Impact of Renal Function Before Mechanical Circulatory Support on Posttransplant Renal Outcomes. Ann Thorac Surg 2011; 91:1348-54. [DOI: 10.1016/j.athoracsur.2010.10.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 10/12/2010] [Accepted: 10/18/2010] [Indexed: 10/18/2022]
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23
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Gude E, Andreassen AK, Arora S, Gullestad L, Grov I, Hartmann A, Leivestad T, Fiane AE, Geiran OR, Vardal M, Simonsen S. Acute renal failure early after heart transplantation: risk factors and clinical consequences. Clin Transplant 2010; 24:E207-13. [DOI: 10.1111/j.1399-0012.2010.01225.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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24
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Chen YC, Chou NK, Hsu RB, Chi NH, Wu IH, Chen YS, Yu HY, Huang SC, Wang CH, Tsao CI, Ko WJ, Wang SS. End-stage renal disease after orthotopic heart transplantation: a single-institute experience. Transplant Proc 2010; 42:948-51. [PMID: 20430213 DOI: 10.1016/j.transproceed.2010.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Orthotopic heart transplantation is the treatment of choice for end-stage heart failure, and calcineurin inhibitor agents allow for better allograft survival. However, pretransplantation low cardiac output status and posttransplantation immunosuppressants contribute toward deterioration of renal function. From 1987 to 2008, 350 patients underwent orthotopic heart transplantation in our hospital. Most of them received anti-thymocyte globulin (ATG) as the induction immunosuppressant. The introduction of mycophenolate mofetil (MMF) reduced the maintenance level of cyclosporine. The 26 patients who developed end-stage renal disease required dialysis. We reviewed the patient characteristics, including pretransplantation status, immunosuppressant regimens and drug levels, time and type of dialysis, and mortality rate. The mean age of these 26 patients was 53 years. Three patients underwent peritoneal dialysis. The overall 1-year survival rate was 96%, and the 5-year survival rate was 80%. The duration from heart transplantation to chronic dialysis correlated with the presence of a pretransplantation diagnosis of diabetes (P<.05) and an elevated pretransplantation blood creatinine level (P=.01), but there was no significant effect of the initial level of cyclosporine. In addition, the pretransplantation blood creatinine level was also related to the necessity of immediate postoperative hemodialysis (P=.01). There was no significant risk factor in relation to mortality. Regardless of modification of immunosuppressant regimens and initial drug levels, pretransplantation kidney function played an important inverse role in the duration from transplantation to dialysis: the higher the pretransplantation blood creatinine, the shorter the duration. While awaiting a heart transplant, more effort should be spent on protecting renal function to avoid early chronic dialysis.
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Affiliation(s)
- Y C Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
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25
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Delgado JF, Crespo-Leiro MG, Gómez-Sánchez MA, Paniagua MJ, González-Vílchez F, Vázquez de Prada JA, Fernández-Yáñez J, Pascual D, Almenar L, Martínez-Dolz L, Díaz B, Roig E, Segovia J, Arizón JM, Garrido I, Blasco T, López J, Brossa V, Manito N, Muñiz J. Risk factors associated with moderate-to-severe renal dysfunction among heart transplant patients: results from the CAPRI study. Clin Transplant 2010; 24:E194-200. [DOI: 10.1111/j.1399-0012.2010.01249.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Current world literature. Curr Opin Organ Transplant 2010; 15:254-61. [PMID: 20351662 DOI: 10.1097/mot.0b013e328337a8db] [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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27
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Gude E, Gullestad L, Arora S, Simonsen S, Hoel I, Hartmann A, Holdaas H, Fiane AE, Geiran OR, Andreassen AK. Benefit of early conversion from CNI-based to everolimus-based immunosuppression in heart transplantation. J Heart Lung Transplant 2010; 29:641-7. [PMID: 20304681 DOI: 10.1016/j.healun.2010.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Revised: 01/14/2010] [Accepted: 01/17/2010] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Calcineurin inhibitor (CNI)-induced nephrotoxicity is a feared adverse effect after heart transplantation (HTx). In patients with advanced renal failure we performed an overnight conversion from cyclosporine (CsA) to everolimus within the first year after HTx and compared changes in renal function to a similar switch performed in a group of long-term HTx survivors with 24-month follow up. METHODS Sixteen HTx recipients (Group 1), including 5 patients undergoing dialysis, were switched overnight from CsA to everolimus at 5.5 (range 1.3 to 8.5) months post-operatively, whereas 15 patients completed 24 months of follow-up. Fifteen long-term survivors (Group 2) were recruited at 96 (58 to 148) months post-HTx. Due to 3 withdrawals and 2 deaths, 10 of these 15 patients remained available for follow-up assessment. RESULTS In Group 1 patients, creatinine level improved from 211 (186 to 263) to 112 (98 to 140) mumol/liter and estimated glomerular filtration rate (eGFR) from 29 (20 to 35) to 62 (43 to 69) ml/min/1.73 m(2) (p < 0.001). In Group 2, creatinine decreased from 227 (188 to 255) to 193 (150 to 250) micromol/liter (p = 0.299), and eGFR increased from 26 (21 to 31) to 28 (22 to 35) ml/min/1.73 m(2) (p = 0.225). Four cellular rejections were treated successfully in Group 1. All together, 24 adverse events occurred. CONCLUSIONS These preliminary data are the first to suggest that the improvement in renal function after switching to CNI-free everolimus treatment has the greatest potential within the first year post-HTx. While we await randomized, controlled trials, it appears that conversion can be performed with acceptable safety in selected patients.
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Affiliation(s)
- Einar Gude
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.
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28
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Oda N, Kato TS, Komamura K, Hanatani A, Mano A, Hashimura K, Asakura M, Niwaya K, Funatsu T, Kobayashi J, Wada K, Hashimoto S, Ishibashi-Ueda H, Nakano Y, Kihara Y, Kitakaze M. Clinical Course and Outcome of Heart Transplant Recipients Single Center Experience at the National Cardiovascular Center in Japan. Int Heart J 2010; 51:264-71. [DOI: 10.1536/ihj.51.264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Noboru Oda
- Department of Cardiovascular Medicine, National Cardiovascular Center
- Department of Cardiovascular Medicine, Hiroshima University Hospital
| | - Tomoko S. Kato
- Department of Cardiovascular Medicine, National Cardiovascular Center
- Department of Organ Transplantation, National Cardiovascular Center
| | - Kazuo Komamura
- Department of Cardiovascular Medicine, National Cardiovascular Center
- Department of Organ Transplantation, National Cardiovascular Center
| | - Akihisa Hanatani
- Department of Cardiovascular Medicine, National Cardiovascular Center
- Department of Organ Transplantation, National Cardiovascular Center
| | - Akiko Mano
- Department of Cardiovascular Medicine, National Cardiovascular Center
- Department of Organ Transplantation, National Cardiovascular Center
| | | | - Masanori Asakura
- Department of Cardiovascular Medicine, National Cardiovascular Center
| | - Kazuo Niwaya
- Department of Cardiovascular Surgery, National Cardiovascular Center
| | - Toshihiro Funatsu
- Department of Cardiovascular Surgery, National Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cardiovascular Center
| | - Kyoichi Wada
- Department of Pharmacology, National Cardiovascular Center
| | - Shuji Hashimoto
- Department of Clinical Physiology, National Cardiovascular Center
| | | | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Hospital
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Hospital
| | - Masafumi Kitakaze
- Department of Cardiovascular Medicine, National Cardiovascular Center
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Pham PTT, Slavov C, Pham PCT. Acute kidney injury after liver, heart, and lung transplants: dialysis modality, predictors of renal function recovery, and impact on survival. Adv Chronic Kidney Dis 2009; 16:256-67. [PMID: 19576556 DOI: 10.1053/j.ackd.2009.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recipients of nonrenal organ transplants including the liver, heart, and lung are at risk for developing acute kidney injury (AKI) and chronic kidney disease (CKD). Underlying hepatic or cardiopulmonary failure, prolonged intraoperative hemodynamic instability, and the use of calcineurin inhibitors and nephrotoxic medications have all been suggested to be contributory. The incidence of perioperative AKI has been reported to occur in 17% to 95% in liver transplant recipients, 5% to 30% in heart transplant recipients, and 5% to 60% in recipients of lung transplants. Among those who develop AKI, renal replacement therapy is required in 5% to 35%, 5% to 15%, and 8% to 10% in liver, heart, and lung transplant recipients, respectively. The current article presents an overview of the literature on the choice of dialysis modality and its associated advantages and disadvantages in the management of AKI after liver, heart, and lung transplants. Predictive factors for renal function recovery and the impact of AKI and CKD on survival will also be discussed.
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