Although previous publications have discussed
kidney disease in nonrenal solid-
organ transplantation, none has reviewed thoroughly the potential predictors of long-term renal impairment in cardiac recipients. Thus, the purpose of this review article is to summarize the current state of knowledge on risk factors of
chronic renal insufficiency in heart transplant patients. An English language Medline literature search (1946-April 2014) was conducted using the search terms
renal insufficiency,
kidney failure,
kidney diseases, nephrotoxi$ ($ for truncation),
creatinine, glomerular filtration rate,
heart transplantation and
organ transplantation. Additional references were identified from a review of literature citations. A total of 74 articles discussing key risk factors were included in the manuscript. The existing literature reveals that several recipient characteristics (age, female sex, pretransplant/early post-transplant kidney impairment, diabetes, and
hypertension) increase the risk of
renal insufficiency after
transplantation. Current data also indicate that, while
cyclosporine and
tacrolimus are most likely major determinants of post-transplant
kidney failure, the effects of
calcineurin inhibitor doses and concentrations remain unclear. A small number of studies suggest that
tacrolimus could possibly induce less nephrotoxicity than
cyclosporine, but meta-analyses of randomized controlled trials show the opposite with comparable incidences of dialysis after
cardiac transplantation. Finally, the role of genetic variations has only been explored to a limited extent in heart transplant patients. This growing body of evidence should ultimately lead to a better risk prediction regarding
chronic renal insufficiency following
cardiac transplantation and a more personalized tailoring of immunosuppressive regimens.