Incidence, Determinants, and Outcome of Chronic Kidney Disease After Adult Heart Transplantation in the United Kingdom

SummaryRenal insufficiency (RI) is a frequent complication in heart transplant (HT) patients. The main objectives of the Cardiac trAnsplantation and Renal INsufficiency (CARIN) study were to follow the evolution of renal function after heart transplantation (HTx), to identify the factors associated with the decline of renal function, to describe the impact of RI on mortality during 3 years after the HT, and to observe the renal profile of the prescriptions. CARIN was a French retrospective, multicentric, study. Data were collected for patients who received a HT between 2000 and 2005. Data collection was performed at five time points: before HTx (T0), 1(T1), 6(T6), 12 (T12), and 36 (T36) months after HTx. Glomerular filtration rate (GFR) was estimated with aMDRD formula. RI was defined as GFR < 60 ml/min/1.73 m². Four hundred and forty-one patients from five HT centers were included. The prevalences of RI were 28.8% (T0), 54.0% (T1), 50.4% (T6), 51.6% (T12), and 59.6% (T36). Age and cyclosporine were independently linked to the decline of renal function. Hypertension and GFR < 60 at T0 were independent risk factors of mortality. 48.7-64.7% of the nonimmunosuppressive prescriptions were drugs that required dosage adjustment in RI patients or for which no data were available concerning administration in RI patients. RI is highly frequent after HTx. Because RI is a risk factor of mortality, any sparing renal strategies have to be undertaken.

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“…Indeed, renal failure after HTx is associated with significant mortality and morbidity . Ojo et al .…”

Section: Introductionmentioning

confidence: 99%

Renal insufficiency, mortality, and drug management in heart transplant. Results of the CARIN study

et al. 2014

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“…This gain in shortterm life expectancy, however, has increased awareness of the side effects associated with CNI-based immunosuppression and shifted attention toward strategies that could reduce long-term CNI-related morbidity (3). In particular, chronic renal failure occurs in approximately 11% of heart transplant recipients during the first 5 years posttransplant (4,5), and is associated with more than a fourfold increase in mortality (4). A major cause of renal injury, at least in the early posttransplant period, is CNIrelated nephrotoxicity (6).…”

Section: Introductionmentioning

confidence: 99%

Everolimus Initiation and Early Calcineurin Inhibitor Withdrawal in Heart Transplant Recipients: A Randomized Trial

Andreassen

Andersson

Gustafsson

et al. 2014

American Journal of Transplantation

131

118

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“…In fact, Group 1 (non-overweight) had almost doubled the percentage of female patients as compared to Group 2 (29.6% vs 15.9%). Previous ISHLT registry reports, 1,9,39,40,42 as well as numerous other studies, 43–46,49–52 have shown worse outcomes in female HT recipients in such areas as mortality, re-hospitalization, rejection, and renal dysfunction.…”

Section: Discussionmentioning

confidence: 86%

Clinical outcomes in overweight heart transplant recipients

2016

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Background There is a paucity of research examining the impact of patient weight after heart transplant (HT) on multiple clinical outcomes. Objectives The purpose of this study was to compare 9 clinical outcomes in 2 groups of HT recipients (N = 347) from 2 hospitals in the midwestern and southern United States, based on their mean body mass index (BMI) during the first 3 years post-HT, and to identify risk factors for mortality. Methods The sample was divided into 2 groups: Group 1: 108 non-overweight patients (BMI <25; mean age 52; 29.6% females; 16.7% minorities), and Group 2: 239 overweight patients (BMI ≥25; mean age 52; 15.9% females; 13.8% minorities). Outcomes examined 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. Mortality risk factors were: higher prednisone dose, higher cholesterol, earlier IV-treated infection, severe renal dysfunction, respiratory failure, and female patient. 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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Incidence, Determinants, and Outcome of Chronic Kidney Disease After Adult Heart Transplantation in the United Kingdom

Cited by 47 publications

References 34 publications

Renal insufficiency, mortality, and drug management in heart transplant. Results of the CARIN study

Renal insufficiency, mortality, and drug management in heart transplant. Results of the CARIN study

Everolimus Initiation and Early Calcineurin Inhibitor Withdrawal in Heart Transplant Recipients: A Randomized Trial

Clinical outcomes in overweight heart transplant recipients

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