Treatment of end-stage renal failure after heart transplantation

Frimat, Luc; Jp, Villemot; Cormier, Laurent; Cao-Huu, T.; Renoult, E.; Hestin, D.; Dopff, C.; Mattei, S; J, Hubert; Kessler, M.

doi:10.1093/ndt/13.11.2905

Cited by 43 publications

(26 citation 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: Discussionsupporting

confidence: 79%

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: Discussionsupporting

confidence: 79%

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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“…End-stage kidney disease has been reported as high as 10% at 5 years and 20% at 10 years postheart transplantation (1)(2)(3)(4)(5). Following heart transplantation, patients who progress to chronic dialysis bear a 3-fold increased risk of death compared to those without endstage kidney disease (1,4,6). Moreover, heart transplant patients requiring chronic dialysis experience an increased mortality compared to matched patients on dialysis (7).…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have suggested that CsA nephrotoxicity could result from individually determined susceptibility (9)(10)(11). (12,13 Figures 1 and 2), and that CrCl DROP [1][2][3][4][5][6][7][8][9][10][11][12] >30% was a significant predictor of all-cause mortality (Table 3, Figure 3). Logrank test p=0.03 (12).…”

Section: Introductionmentioning

confidence: 99%

The Clinical Impact of an Early Decline in Kidney Function in Patients Following Heart Transplantation

Cantarovich

Hirsh

Alam

et al. 2009

American Journal of Transplantation

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Renal dysfunction is a well-known complication following heart transplantation. We examined an early decline in kidney function as a predictor of progression to end-stage renal disease and mortality in heart transplant recipients. We performed a retrospective cohort study of 233 patients who received a heart transplant between July 1985 and July 2004, and who survived >1 month. The decline in estimated creatinine clearance (CrCl) was used to predict the outcomes of need for chronic dialysis or mortality >1-year posttransplant. The earliest time to chronic dialysis was 484 days. A 30% decline in CrCl between 1 month and 12 months predicted the need for chronic dialysis (p = 0.01), all-cause mortality (p < 0.0001) and time to first CrCl ≤30 mL/min at >1-year posttransplant (p = 0.02). A 30% decline in CrCl between 1 month and 3 months also independently predicted the need for chronic dialysis (p = 0.04) and time to first CrCl ≤ 30 mL/min at >1-year posttransplant (p = 0.01). In conclusion, an early drop in CrCl within the first year is a strong predictor of chronic dialysis and death >1-year postheart transplantation. Future studies should focus on kidney function preservation in those identified at high risk for progression to end-stage kidney disease and mortality.

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“…Renal impairment and ESRF associated with HT result in an excessive risk of mortality in HT patients [1][2][3]9,15]. However no conclusive studies compared survival after dialysis onset in HT patients vs non-heart transplant (non-HT) patients [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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

Villar

Boissonnat

Sebbag

et al. 2007

Nephrology Dialysis Transplantation

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Background. Chronic kidney disease (CKD) and endstage renal failure (ESRF) are major complications after a heart transplant. The aim of this study is to compare survival in heart transplant (HT) vs non-heart transplant (non-HT) patients starting dialysis. Methods. Survival was studied among the 539 newly dialysed patients between 1 January 1995 and 31 December 2005 in our Department. All patients were prospectively followed from the date of first dialysis up to death or 31 December 2005. Multivariate survival analysis adjusted on baseline characteristics was performed with the Cox model. Results. There were 21 HT patients and they were younger than non-HT patients at first dialysis: 58.6 AE 11.6 vs 63.0 AE 16.2 years (P ¼ 0.09). Calcineurin inhibitor nephrotoxicity was the main cause of ESRF in HT patients (47.6%). Crude 1, 3 and 5-year survival rates in HT and in non-HT patients were as follows: 76.2%, 57.1%, 28.6% and 79.1%, 58.7%, 46.7% (P ¼ 0.2). The adjusted hazard ratio of death in HT vs non-HT patients was 2.27 [1.33-3.87], P ¼ 0.003. Sudden death was the main cause of death in HT patients, in 33.3% vs 10.4% in non-HT patients (P ¼ 0.01). Five HT patients benefited from renal transplant. They were all alive at the end of the study period, while one patient among the 16 remaining on dialysis survived. Conclusion. HT patients with CKD who reached ESRF have a poor outcome after starting dialysis in comparison with other ESRF patients. Improvement in renal function management in the case of CKD is needed in these patients and non-nephrotoxic immunosuppressive regimens have to be evaluated. Renal transplant should be the ESRF treatment of choice in HT patients.

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Treatment of end-stage renal failure after heart transplantation

Abstract: HD, PD, and RT can be useful for the treatment of ESRF after heart transplantation. After initiating HD, patient survival is nearly the same as that reported in patients in Europe undergoing HD for other causes. But ESRF seems to reduce life expectancy in heart-transplant recipients.

Cited by 43 publications

References 0 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

The Clinical Impact of an Early Decline in Kidney Function in Patients Following Heart Transplantation

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

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