Long-term renal function in heart transplant children on cyclosporine treatment

Abstract

Renal function deterioration is a reason of concern in heart transplantation. Our aim was to evaluate long-term renal function in heart transplant children on cyclosporine (CsA) treatment and to investigate the effect of several variables possibly involved in renal function deterioration. Creatinine clearances were retrospectively reviewed in 50 children (median follow 99.7 months after heart transplant). Gender, age, and body weight at transplant, rejection episodes, CsA cumulative dose, and trough levels were analyzed. After an initial increase of the glomerular filtration rate (GFR), renal function worsened in most patients; 28% of the children developed renal insufficiency (defined as GFR <80 ml/min per 1.73 m2), which was already evident in the first 3 years. Neither CsA dose, trough levels, nor other patient characteristics were found to be associated with renal function deterioration. In this study renal failure occurred in one-third of the patients. The lack of association of CsA with renal insufficiency may be explained by several reasons, including the limitations of the retrospective design of the study. However, it is possible that the nephrotoxic effect of CsA is more likely to occur in a set of predisposed patients. These must be soon identified to evaluate early a calcineurin inhibitor-sparing strategy.

The profile of renal function over time in a cohort of pediatric heart transplant recipients

“…For instance, Dello Strologo and Phan both reported mean cohort cGFR post‐transplant of approximately 100 mL/min/1.73 m 2 at 10 months and between one and four yr, respectively. Thus, even a 20 mL/min/1.73 m 2 overestimation would place the GFR mean for the entire cohort near 80 mL/min/1.73 m 2 , the authors’ cut‐off for renal insufficiency in both studies (11, 17).…”

“…While the overestimation of renal function by the cGFR based on creatinine clearance has already been reported (15), this study also found that on a cohort‐wide basis, relying solely on cGFR could greatly underestimated the burden of renal disease following pediatric transplantation. Most pediatric heart transplantation studies looking at renal insufficiency have used estimated GFR calculated with the Schwartz formula (9, 11, 13, 14, 16, 17). While it is impossible to predict the extent to which the use of cGFR overestimated GFR in other patient populations, our results (Fig.…”

“…Studies on adult heart transplant patients report a rapid decline in renal function during the first year post‐transplant followed by relative stability or a progressive slower decline (2, 4–7). The pediatric data are varied, with some studies showing stability after an initial reduction in renal function (8–11), others a strong initial decline followed by slower deterioration (12–16), one showing an improvement over time (17), and another reporting long‐term stability in function (18). Unfortunately, there is little consistency in the pediatric heart transplant literature with respect to the definition of renal insufficiency or the methods used to assess renal function.…”

Renal Transplantation After Previous Pediatric Heart Transplantation

“…Some survivors develop end-stage renal disease (ESRD), requiring renal replacement therapy, either with dialysis or renal Tx. 1,2,8 A recent analysis of national transplant data estimated that, after pediatric heart Tx, the 10-year actuarial risks for development of ESRD and chronic renal insufficiency (CRI) were 4.3% and 11.8%, respectively. 9 Furthermore, development of renal impairment was shown to be associated with a 9-fold increased risk of mortality.…”

“…[1][2][3][4] After the advent of cyclosporine in the 1980s, survival rates after pediatric heart transplantation (Tx) have been improving steadily. [5][6][7] With improving long-term survival after pediatric heart Tx, renal dysfunction is gaining increased attention.…”