Risk Factors for Chronic Renal Dysfunction in Cardiac Allograft Recipients

Abstract

Renal dysfunction is one of the most common and threatening complications in heart transplant recipients. Even if ciclosporin seems to play a central role in inducing renal damage, other factors may concur or predispose to renal injury. In order to identify factors responsible for renal dysfunction, we retrospectively studied a cohort of 114 cardiac transplant recipients during a follow-up period of at least 3 years. The patients had a normal renal function before and 0.5 months after heart transplantation. Doubling of baseline serum creatinine or attainment of serum creatinine steadily above 176.8 µmol/l (2.0 mg/dl) was used as criterion to define the end-point renal dysfunction. A series of clinical and laboratory variables were obtained from the patients’ charts at different time intervals, and their prognostic value for the occurrence of renal dysfunction was calculated by Cox proportional hazards models. 23 out of 114 patients reached the end point after a median time period of 21 months. High serum triglyceride, alanine aminotransferase, alkaline phosphatase, ciclosporin, urea, glucose, and hemoglobin levels were shown to be associated with the development of renal dysfunction. Four variables, i.e., triglyceride, ciclosporin, urea, and alkaline phosphatase, had an independent prognostic value. Our results confirm a role for ciclosporin in inducing renal dysfunction and identify hyperlipidemia and an increased plasma urea level as risk factors for renal dysfunction in heart transplant recipients.

Determination of renal function in long-term heart transplant patients by measurement of urinary retinol-binding protein levels

“…Here, we report a 30-54% prevalence of renal dysfunction in heart transplant recipients, similar to that reported by others (2,7,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). When we considered creatinine clearance (<60 mL min -1 (1.73 m 2 ) -1 ), we could observe that serum creatinine (>1.5 mg/dL) underestimated the real incidence, indicating that its routine interpretation should be made with caution.…”

“…Its prevalence ranged from 3 to 10%, probably due to differences in the transplant follow-up time, to the criteria used to define renal impairment, to the cyclosporine dose used in the maintenance phase of transplantation, and to the interpopulation variability (2,7,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Recently, it has been demonstrated in a large group of patients that heart transplantation is associated with a 10.9% 5-year cumulative incidence of chronic renal failure (20).…”

Acute Renal Failure and Its Impact on Survival Following Cardiac Transplantation

“…Renal dysfunction occurs in patients waiting for cardiac transplanataion with severe cardiac failure due to low cardiac output and hormonal instability (11,12). In our study the earlylast echocardiographic evaluation was similar in both groups.…”

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

“…Many studies have addressed this issue in heart transplant: the degree of renal insufficiency has been found to be associated with preoperative renal function [14], age of recipients, and GFR 1 year after transplantation [15]. Many authors have suggested that cyclosporine and early exposure to this drug causes renal deterioration in heart transplant children [3,5,16,17]. Other authors have raised doubts about a direct nephrotoxic effect of CsA [18][19][20].…”

“…Among these, renal function deterioration, which severely affects 7% of patients [glomerular filtration rate (GFR) less than 29 ml/min] 3 years after transplantation [2], has become an important issue. The introduction of nephrotoxic drugs like calcineurin inhibitors inducing reversible renal vasoconstriction [3][4][5] has been considered responsible for renal damage, but the issue is still controversial. Heart transplantation provides a good model to investigate the effect of cyclosporine (CsA) on long-term renal function, whereas studies performed on patients after renal transplantation are complicated by the occurrence of confounding factors such as chronic rejection, recurrence of primary renal disease, de novo nephropathies, urinary tract infections, and subclinical rejections.…”