Published data have shown potential advantages of levosimendan in the management of acute decompensated heart failure and advanced heart failure when standard medical therapies threaten hemodynamics and organ perfusion are unable to alleviate clinical symptoms. Levosimendan distinguishes itself from other catecholaminergic inotropes by its three mechanisms of action: positive inotropy, vasodilation, and cardioprotection. In addition, its pharmacokinetics allow for a longer duration of action from the metabolite OR1896 allowing for further cardiovascular therapeutic effects for several days, even after discontinuation of the parent drug.
Background:
We compared effects of immunosuppression and co-morbidities on kidney function following renal transplant.
Methods:
We perfomed retrospective chart review in 211 consecutive renal transplant recipients, treated at a single medical center between 2004 to 2014, who also underwent a post-transplant echocardiogram. Patients were stratified into ESRD/CKD-4 group and CKD1-3 according to standard GFR criteria. The study was approved by IRB.
Results:
Average age was 52.4 +/- 11.8 years old, 41% were females, 95% with history HTN, 81% with dislipidemia, 20% with CAD, 42% with diabetes mellitus, 26% past smokers, 16% on thyroid replacement therapy, 8% with history of congestive heart failure. The average hemoglobin was 11.9 +/- 2.2 mg/dL. Sixty percent of patients were on triple immunosuppressive therapy. In our study cohort, with an average time post-kidney transplant of 41.7+/-34.8 months, 26.5% patients had ESRD/CKD-4. Female gender (OR 2.26, 95% CI 1.21-4.20; p=0.01), diabetes mellitus (OR 0.502, 95% CI 0.26-0.96; p=0.03), triple immunosuppressive therapy (OR 0.279, CI 0.15-0.23; p<0.0001), and hemoglobin (OR 0.632, 95% CI 0.53-0.76; p<0.0001) were significant independent predictors of post-kidney transplant GFR. In multivariable regression analysis, post-transplant hemoglobin (OR 0.641, 95% CI 0.53-0.77; p<0.0001) and triple immunosuppressive therapy (OR 0.282, CI 0.15-0.53; p=0.0004) were significant predictors of preserved GFR and lower CKD category.
Conclusions:
Higher Hgb levels and triple immune-suppressive therapy are associated with improved kidney function post-renal transplant. Additional studies are needed to identify causes of decreased hemoglobin in this patient population and to develop treatment strategies aimed at preserving GFR.
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