Poor prognosis of heart transplant patients with end-stage renal failure

Villar, Emmanuel; Boissonnat, P.; Sebbag, Laurent; Hendawy, Achraf; Cahen, RÃ©mi; Trolliet, Pierre; Labeeuw, M; Ecochard, R; Pouteil‐Noble, Claire

doi:10.1093/ndt/gfl811

Cited by 26 publications

(15 citation statements)

References 36 publications

(60 reference statements)

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“…After 5 years, those transplanted had a survival of 78.6% versus 15.7% for those on dialysis. Similar findings were reported in two papers while a third one noted much lower survival after kidney transplantation [64][65][66]. Finally, concomitant kidney transplantation and OHT have been anecdotally performed [67].…”

Section: Kidney Transplantationsupporting

confidence: 80%

Cardiac Troponin I Level in STEMI and Clinical Correlation with Left Ventricular Dysfunction in Indian Population

Sharma¹,

Sharma²

2013

J Cardiovasc Dis Diagn

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Calcium Channel Blockers (CCBs): CNIs cause vasoconstriction as noted above. CCBs, specifically vasodilating dihydropyridines, have been shown to improve renal plasma flow and GFR [9,16]. A small prospective study comparing amlodipine to placebo showed a slower decline in GFR at one year [13]. There was no effect on LV mass and only a modest decrease in proteinuria. Diltiazem did not appear to offer the same protection [14]. RAAS Inhibitors:The use of RAAS inhibitors is beneficial in most patients with CKD; however, this has not been shown in OHT patients. A systematic review of randomized studies in CSA-treated kidney AbstractBackground: The use of calcineurin inhibitors revolutionized transplantation by prolonging patients' survival. However, their utility is limited by the development of significant chronic kidney disease. Methods:We reviewed the English literature looking for recent publications regarding the management of chronic kidney disease in cardiac transplant patients. We chose relevant papers based on design, number of patients and clinical utility.Results: Most publications on the subject involve small populations with few prospective, randomized studies. Early use of tacrolimus appears to be associated with better kidney function after one year compared to cyclosporine. Once chronic kidney disease is established, successful strategies include reduction or elimination of calcineurin inhibitors while relying on mycophenolate mofetil, proliferation signal inhibitors or anti-CD 25 antibodies to prevent rejection. There is no follow up longer than two years with these approaches. Kidney transplantation might offer improved long-term survival compared to dialysis in end-stage disease. Conclusions:Prospective studies with long-term follow-up are needed to decide about the timing and to confirm the utility of replacing calcineurin inhibitors with other agents in cardiac transplant patients with chronic kidney disease. transplant patients show, after a median of 27 months, a reduction in GFR (around 5.8 cc/min) with a reduction of proteinuria (decrease of 470 mg/day) [17]. It is uncertain if the reduction in proteinuria would translate into better outcomes in the long run. In fact, Opelz et al. showed, in a retrospective study of 1,744 OHT patients, that the use of RAAS inhibitors did not improve patient survival after 6 years [18]. The same study looked at 17,209 kidney transplant patients and showed no difference in graft or patient survival [18]. The use of spironolactone in rat models prevented the decline in GFR and the histologic changes seen with CSA [19]. There are no data in patients. Management of Calcineurin Modification of immunosuppressive drugsTransplant centers have tried multiple immunosuppressive strategies in OHT patient with CKD to prevent progression of renal dysfunction. Most of the data come from small studies, limiting the strength of recommendations that can be made. Larger studies come usually from kidney transplantation literature. Tacrolimus:In small studies, Tacrolimus (TAC) do...

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Section: Kidney Transplantationsupporting

confidence: 80%

Cardiac Troponin I Level in STEMI and Clinical Correlation with Left Ventricular Dysfunction in Indian Population

Sharma¹,

Sharma²

2013

J Cardiovasc Dis Diagn

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“…Children with CKD face many complications including hypertension, dyslipidemia, cardiovascular disease, anemia, bone disease, growth retardation, neurocognitive impairment, and poor quality of life. 4,5,[19][20][21][22][23][24][25] Our analysis identifies a high-risk population for ESKD; targeting renoprotective interventions to these children in earlier stages of kidney disease may decrease CKDrelated morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

End-Stage Kidney Disease After Pediatric Nonrenal Solid Organ Transplantation

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: End-stage kidney disease (ESKD) causes significant morbidity and mortality after solid organ transplantation. Adults commonly develop advanced kidney disease, particularly after liver and intestinal transplantation. Previous pediatric studies have not compared the relative incidence of ESKD by organ type. WHAT THIS STUDY ADDS:This national cohort study shows the highest risk of ESKD among pediatric lung and intestinal transplant recipients, reflecting unique organ-specific causes of kidney injury. Our findings have implications for screening for and treating early kidney disease in transplant recipients. abstract OBJECTIVES: Adult solid organ transplant (SOT) recipients commonly develop advanced kidney disease; however, the burden of end-stage kidney disease (ESKD) in children after SOT is not well-described. The objectives of this study were to determine the incidence of ESKD after pediatric SOT and the relative risk by SOT type. METHODS:Retrospective multicenter cohort study of children, ages #18 years, who received SOTs from 1990 through 2010 using Scientific Registry of Transplant Recipients data linked to the US Renal Data System. We performed a competing risks analysis to determine cumulative incidence of ESKD (chronic dialysis or kidney transplant), treating death as a competing risk, and fit a multivariable Cox regression model to assess hazard of ESKD by organ type. RESULTS:The cohort included 16 604 pediatric SOT recipients (54% liver, 34% heart, 6% lung, 6% intestine, and 1% heart-lung). During a median follow-up of 6.2 years (interquartile range 2.2-12.1), 426 (3%) children developed ESKD. Compared with liver transplant recipients, in whom the incidence of ESKD was 2.1 cases per 1000 person-years, in adjusted analyses the highest risk of ESKD was among intestinal (hazard ratio [HR] 7.37, P , .001), followed by lung (HR 5.79, P , .001) and heart transplant recipients (HR 1.79, P , .001). CONCLUSIONS:In a 20-year national cohort of pediatric SOT recipients, the risk of ESKD was highest among intestinal and lung transplant recipients. The burden of earlier stages of chronic kidney disease is probably much higher; modifiable risk factors should be targeted to prevent progressive kidney damage in this high-risk population.

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“…Renal failure in these patients has been found to be a major risk factor for patient survival, mainly after heart and lung transplantation (4,6,7,14,(20)(21)(22)(23). Calcineurin- (24)(25)(26)(27).…”

Section: Transplanted Kidneys Fail After Years For Various Poorly Defmentioning

confidence: 99%

Biopsy‐Diagnosed Renal Disease in Patients After Transplantation of Other Organs and Tissues

Schwarz¹,

Haller²,

Schmitt³

et al. 2010

American Journal of Transplantation

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Renal function deteriorates in about half of patients undergoing other transplants. We report the results of 105 renal biopsies from 101 nonrenal transplant recipients (bone marrow 14, liver 41, lung 30, heart 20). Biopsy indications were protracted acute renal failure (9%), creatinine increases (83%), heavy proteinuria (22%), or renal insufficiency before re-transplantation (9%). Histological findings other than nonspecific chronic changes, hypertension-related damage, and signs of chronic CNI toxicity included primary glomerular disease (17%), mostly after liver transplantation (21%) or after bone marrow transplantation (29%), and thrombotic microangiopathy (TMA) namely (10%). TMA had the most serious impact on the clinical course. Besides severe hypertension, one TMA patient died of cerebral hemorrhage, 5 had hemolyticuremic syndrome, and 6 rapidly developed end-stage renal failure. TMA patients had the shortest kidney survival post-biopsy and, together with patients with acute tubular injury, the shortest kidney and patient survival since transplantation. Nine TMA patients had received CNI, 3 of them concomitantly received an mTOR-inhibitor. CNI toxicity is implicated in most patients with renal failure after transplant of other organs and may play a role in the development of TMA, the most serious complication. However, decreased renal function should not be routinely ascribed to CNI.

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Poor prognosis of heart transplant patients with end-stage renal failure

Cited by 26 publications

References 36 publications

Cardiac Troponin I Level in STEMI and Clinical Correlation with Left Ventricular Dysfunction in Indian Population

Cardiac Troponin I Level in STEMI and Clinical Correlation with Left Ventricular Dysfunction in Indian Population

End-Stage Kidney Disease After Pediatric Nonrenal Solid Organ Transplantation

Biopsy‐Diagnosed Renal Disease in Patients After Transplantation of Other Organs and Tissues

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