Chronic Kidney Disease After Heart Transplantation: A Single Centre Retrospective Study at Skåne University Hospital in Lund 1988-2010

Söderlund, Carl; Rådegran, Göran

doi:10.1016/j.healun.2015.01.834

Cited by 5 publications

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“…In a meta‐analysis of 615 patients, CCTA was shown to have excellent sensitivity, specificity, and NPV for the detection of angiographic CAV 33 . However its widespread use is limited by the need for ionizing contrast, which is problematic in the chronic heart transplant population due to prevalent chronic kidney disease 34,35 . High sensitivity troponin has been shown to have diagnostic value for severe CAV and to predict adverse outcomes, but its value in the diagnosis of earlier forms of CAV is unknown.…”

Section: Discussionmentioning

confidence: 99%

Donor‐derived cell‐free DNA is associated with cardiac allograft vasculopathy

Holzhauser

Clerkin

Fujino

et al. 2021

Clinical Transplantation

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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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Section: Discussionmentioning

confidence: 99%

Donor‐derived cell‐free DNA is associated with cardiac allograft vasculopathy

Holzhauser

Clerkin

Fujino

et al. 2021

Clinical Transplantation

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“…In this issue of Transplant International , Soderlund et al . . describe a retrospective single‐centre study of 134 heart transplantation (HT) patients from 1988 to 2010 with annual follow‐ups to monitor renal function.…”

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confidence: 99%

Novel, More Accurate Assessments of Renal Function in Heart Transplant Patients: Commentary on ‘Chronic kidney disease after heart transplantation: a single-centre retrospective study at Skåne University Hospital in Lund 1988-2010’

Kim

Eisen

2016

Transpl Int

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Emerging improvements in heart transplantation have led to increased survival and a greater need to better understand the long-term complications of heart transplant. An emerging postsurgical issue of nonrenal solidorgan transplantation is development of chronic kidney disease (CKD), which has been related to significant morbidity and mortality in heart transplant patients that is related to factors that exist before, during and after surgeries. A better understanding of these factors is imperative to predicting and diagnosing CKD in patients with heart transplants.In this issue of Transplant International, Soderlund et al. [1]. describe a retrospective single-centre study of 134 heart transplantation (HT) patients from 1988 to 2010 with annual follow-ups to monitor renal function. Instead of using traditional creatinine-based calculations such as the CKD-EPI, Schwartz or MDRD formulae to estimate glomerular filtration rate (GFR) and incidence of CKD, the authors of this study instead use iohexol clearance measurements. Iohexol clearance has been shown to be a simple, exact and reliable method for such calculations [2].A series of interesting observations were made from their analysis. Particularly, a trend towards steepest GFR declines and CKD progression was observed during the first year post-transplant. Specifically, median GFR decreased from 67.0 during transplant assessment to 56.0 at year 1, 53.0 at year 5 and 44.5 at year 10. On average, GFR declined by 2.2 AE 14.6 ml/min/1.73 m [2] per year post-transplant; however, during the first year, the rate of decline was 11.9 AE 25.8 ml/min/1.73 m [2], much higher. Following in this trend, observations were made that increases in serum creatinine, serum urea, systolic blood pressure and diastolic blood pressure increased over the first year while only slightly increasing if at all after the first year. Taken together, this study suggests that although renal function declines slowly, the majority of the decline occurs early in the first year post-transplant, suggesting this time period is the most critical for monitoring. This time period encompasses the time when the highest doses of calcineurin inhibitors (CNIs) are used, as this is the period of time when rejection is most likely to occur. For this reason, more comprehensive monitoring is required and the use of iohexol to assess GFR provides a more accurate approach for monitoring renal function and preventing deterioration of renal function.In a regression model, proteinuria was the only predictor of steeper GFR decline (>30% in year 1) after ª 2015 Steunstichting ESOT 527

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“…In addition to being removed from blood flow after binding to natriuretic peptide receptor type‐C or possibly receptor type‐A, BNP can also be cleared through proteolysis by enzymes, the most studied of which is neutral endopeptidase (NEP; EC 3.4.24.11), a zinc metalloproteinase or by renal excretion . A large proportion of the HTx develops severe stages of chronic kidney disease (CKD), associated with worse outcome when renal dysfunction arises early, and a higher rate of GFR decline in the presence of early proteinuria . In young children, MacDonald demonstrated that acute kidney injury is common after HT because 73% of pediatric HTx developed acute kidney injury post‐operatively .…”

Section: Increased Bnp In Htx Despite Normal Heart Functionsmentioning

confidence: 99%

Brain natriuretic peptide and right heart dysfunction after heart transplantation

Talha

Charloux

Piquard

et al. 2017

Clinical Transplantation

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Heart transplantation (HT) should normalize cardiac endocrine function, but brain natriuretic peptide (BNP) levels remain elevated after HT, even in the absence of left ventricular hemodynamic disturbance or allograft rejection. Right ventricle (RV) abnormalities are common in HT recipients (HTx), as a result of engraftment process, tricuspid insufficiency, and/or repeated inflammation due to iterative endomyocardial biopsies. RV function follow-up is vital for patient management as RV dysfunction is a recognized cause of in-hospital death and is responsible for a worse prognosis. Interestingly, few and controversial data are available concerning the relationship between plasma BNP levels and RV functional impairment in HTx. This suggests that infra-clinical modifications, such as subtle immune system disorders or hypoxic conditions, might influence BNP expression. Nevertheless, due to other altered circulating molecular forms of BNP, a lack of specificity of BNP assays is described in heart failure patients. This phenomenon could exist in HT population and could explain elevated BNP plasmatic levels despite a normal RV function. In clinical practice, intra-individual change in BNP over time, rather than absolute BNP values, might be more helpful in detecting right cardiac dysfunction in HTx.

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Chronic Kidney Disease After Heart Transplantation: A Single Centre Retrospective Study at Skåne University Hospital in Lund 1988-2010

Cited by 5 publications

References 0 publications

Donor‐derived cell‐free DNA is associated with cardiac allograft vasculopathy

Donor‐derived cell‐free DNA is associated with cardiac allograft vasculopathy

Novel, More Accurate Assessments of Renal Function in Heart Transplant Patients: Commentary on ‘Chronic kidney disease after heart transplantation: a single-centre retrospective study at Skåne University Hospital in Lund 1988-2010’

Brain natriuretic peptide and right heart dysfunction after heart transplantation

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