Chronic cyclosporine-induced nephrotoxiciy in heart transplant patients: Long-term benefits of treatment with mycophenolate mofetil and low-dose cyclosporine

Sánchez, Violeta; Delgado, Juan; Morales, J. M.; Tello, Rocío; Gómez, Mario Arbeláez; Escribano, Pilar; Cámara, Agustı́n Gómez de la; Calzada, Carlos Sáenz de la

doi:10.1016/j.transproceed.2004.09.035

Cited by 28 publications

(21 citation statements)

References 5 publications

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“…To avoid the unwanted side effects of CNIs, various substitutes for high-dose CNI immunosuppression have been developed, including: low-dose CNI protocols; implementation of CNI therapeutic drug monitoring; alternative immunosuppressive strategies based on the use of MMF; sirolimus; and meticulous avoidance of other nephrotoxic drugs. 20,21 The prevalence of early post-transplant renal failure in the entire patient cohort in our study tended to decline during the year of follow-up. Both serum creatinine and urea peaked at 4 weeks, but then steadily declined over 12 months of follow-up; GFR improved concomitantly.…”

Section: Discussionmentioning

confidence: 74%

Natural course and risk factors for impaired renal function during the first year after heart transplantation

Jokinen

Tikkanen

Kukkonen

et al. 2010

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 74%

Natural course and risk factors for impaired renal function during the first year after heart transplantation

Jokinen

Tikkanen

Kukkonen

et al. 2010

The Journal of Heart and Lung Transplantation

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“…Significant dichotomous risk factors were severe renal dysfunction (most likely due to calcineurin-inhibitor immunosuppressants 31-33 ) and diabetes (pre-existing and steroid-induced); both risk factors were greater in Group 2 (female donor-male recipient mismatch). ISHLT registry data 2 and other research 16, 34, 35 have identified pre-existing diabetes as a risk factor for both short-term and long-term mortality after HT.…”

Section: Discussionmentioning

confidence: 99%

First-Year Clinical Outcomes in Gender-Mismatched Heart Transplant Recipients

Jalowiec

Grady

White‐Williams

2012

Journal of Cardiovascular Nursing

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Background Research indicates that gender mismatch of organ donor and recipient may adversely affect outcomes in heart transplant (HT) patients. However, there is a paucity of literature on gender-mismatched outcomes in patients receiving a HT, and only a few outcomes have been investigated. Objectives Objectives were to: (1) determine if gender-mismatched HT recipients experienced decreased survival, more post-transplant complications, and more days hospitalized during the first post-operative year as compared to gender-matched recipients; and (2) identify risk factors for decreased survival. Methods Patients were 347 HT recipients; 21.3% (74) received a heart from the opposite gender. Three groups were compared: Group 1: same gender donor-recipient (273, 78.7%: 36 women, 237 men); Group 2: female donor-male recipient (40, 11.5%); Group 3: male donor-female recipient (34, 9.8%). Ten outcomes were compared with Kaplan-Meier survival analysis, logistic regression, and MANCOVA, using a Bonferroni-adjusted P ≤.005. Risk factors for decreased survival were examined with Cox regression. Results Gender-mismatched HT patients with a male donor and a female recipient (Group 3) had more treated acute rejections and were rehospitalized more days after HT discharge during the first post-operative year as compared to gender-matched patients. No significant differences were found in 8 other first-year outcomes: number of deaths, survival time, hospital length of stay for HT surgery, cardiac allograft vasculopathy, severe renal dysfunction, new-onset steroid-induced diabetes, non-skin cancers, or the number of infections treated with an intravenous (IV) antibiotic. Risk factors for decreased year 1 survival were higher year 1 cholesterol, earlier IV-treated infection, severe renal dysfunction, earlier treated rejection, and diabetes (both pre-existing and new-onset steroid-induced diabetes). Conclusion Gender-mismatched HT recipients had more complications due to rejection and higher resource utilization due to more rehospitalization during the first post-operative year as compared to gender-matched recipients. Therefore, these problem areas may provide targets for possible interventions.

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“…6,7 Moreover, repeated high-dose corticosteroid therapy combined with other immunosuppressants induce treatment-related severe adverse effects such as opportunistic infections, and could make any more aggressive immunosuppressive treatments impossible. [8][9][10][11] Indeed, our patient showed resistance to various combination therapies of corticosteroid and immunosuppressants including even repeated IVCY and finally developed severe opportunistic infection. However, the UT bolus infusion successfully rescued the patient and induced remission of IP even while the corticosteroid was tapered.…”

Section: Discussionmentioning

confidence: 85%

“…6,7 In addition, these agents are not always tolerated because of various adverse effects including opportunistic infections. [8][9][10][11] We often experience IP that is not suppressed sufficiently by immunosuppressive treatments and cannot keep administering immunosuppressive treatments because of adverse effects. Therefore, the was tapered to 0.4 mg/kg BW per day, but her IP soon worsened again.…”

Section: Case Reportmentioning

confidence: 99%

Human urinary trypsin inhibitor bolus infusion improved severe interstitial pneumonia in mixed connective tissue disease

et al. 2005

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Interstitial pneumonia (IP) with mixed connective tissue disease (MCTD) often progresses despite immunosuppressive therapies that caused serious infections. Human urinary trypsin inhibitor (UT) inhibits inflammatory factors associated with IP, without immunosuppression. UT bolus infusion rescued a female MCTD patient with refractory IP and severe opportunistic fungal pneumonia. Her IP diminished with monthly UT bolus infusion despite tapering of prednisolone, without UT-related side effects. UT pulse therapy could prove beneficial for refractory IP in MTCD even with opportunistic infections.

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Chronic cyclosporine-induced nephrotoxiciy in heart transplant patients: Long-term benefits of treatment with mycophenolate mofetil and low-dose cyclosporine

Cited by 28 publications

References 5 publications

Natural course and risk factors for impaired renal function during the first year after heart transplantation

Natural course and risk factors for impaired renal function during the first year after heart transplantation

First-Year Clinical Outcomes in Gender-Mismatched Heart Transplant Recipients

Human urinary trypsin inhibitor bolus infusion improved severe interstitial pneumonia in mixed connective tissue disease

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