HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Chronic renal insufficiency in heart transplant recipients: risk factors and management options.

Abstract
Renal dysfunction after heart transplantation is a frequently observed complication, in some cases resulting in significant limitation of quality of life and reduced survival. Since the pathophysiology of renal failure (RF) is multifactorial, the current etiologic paradigm for chronic kidney disease after heart transplantation relies on the concept of calcineurin inhibitor (CNI)-related nephrotoxicity acting on a predisposed recipient. Until recently, the management of RF has been restricted to the minimization of CNI dosage and general avoidance of classic nephrotoxic risk factors, with somewhat limited success. The recent introduction of proliferation signal inhibitors (PSIs) (sirolimus and everolimus), a new class of immunosuppressive drugs lacking intrinsic nephrotoxicity, has provided a completely new alternative in this clinical setting. As clinical experience with these new drugs increases, new renal-sparing strategies are becoming available. PSIs can be used in combination with reduced doses of CNIs and even in complete CNI-free protocols. Different strategies have been devised, including de novo use to avoid acute renal toxicity in high-risk patients immediately after transplantation, or more delayed introduction in those patients developing chronic RF after prolonged CNI exposure. In this review, the main information on the clinical relevance and pathophysiology of RF after heart transplantation, as well as the currently available experience with renal-sparing immunosuppressive regimens, particularly focused on the use of PSIs, is reviewed and summarized, including the key practical points for their appropriate clinical usage.
AuthorsFrancisco González-Vílchez, José Antonio Vázquez de Prada
JournalDrugs (Drugs) Vol. 74 Issue 13 Pg. 1481-94 (Sep 2014) ISSN: 1179-1950 [Electronic] New Zealand
PMID25134671 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
Chemical References
  • Calcineurin Inhibitors
  • Immunosuppressive Agents
Topics
  • Calcineurin Inhibitors (adverse effects, therapeutic use)
  • Heart Transplantation (methods)
  • Humans
  • Immunosuppressive Agents (adverse effects, pharmacology, therapeutic use)
  • Kidney Failure, Chronic (etiology, physiopathology, prevention & control)
  • Quality of Life
  • Risk Factors

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: