Kidney transplantation as a therapeutic option for end-stage renal disease developing after heart transplantation.

Abstract

BACKGROUND:

Progressive renal failure is a frequent complication after heart transplantation (HTx). It may result in end-stage renal disease (ESRD), prompting consideration of kidney Tx after HTx (KAH).

METHODS:

We performed a retrospective single-center study of 268 HTx recipients to evaluate outcomes after KAH compared with HTx recipients with and without ESRD.

RESULTS:

During a median follow-up of 76 months, ESRD developed in 51 patients (19), and 39 of them (76%) underwent KAH. The mean time from HTx to ESRD was 83 months. The incidence of switching to a calcineurin inhibitor (CNI)-free regimen based on sirolimus was significantly lower among recipients with ESRD (6% vs 57%, p = 0.0001), and prolonged exposure to CNI significantly increased the risk for ESRD (hazard ratio, 1.09; 95% confidence interval, 1.03-1.15; p < 0.005). Death-censored renal graft survival after KAH was 95%, 95%, and 83% at 1, 5, and 10 years, respectively. Median long-term survival of KAH patients was comparable to HTx recipients without ESRD (17.5 vs 17.1 years, p = 0.27) and significantly better compared with HTx recipients with ESRD (17.5 vs 7.3 years, p < 0.001).

CONCLUSIONS:

Prolonged exposure to CNI immunosuppression medications significantly increases the risk for ESRD among HTx recipients. KAH is a good therapeutic option for HTx recipients with ESRD, with survival benefit comparable to HTx without ESRD.

• Authors: Avishay Grupper, Ayelet Grupper, Richard C Daly, Naveen L Pereira, Matthew A Hathcock, Walter K Kremers, Fernando G Cosio, Brooks S Edwards, Sudhir S Kushwaha
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 36 Issue 3 Pg. 297-304 (Mar 2017) ISSN: 1557-3117 [Electronic] United States
• PMID: 27642059 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2017. Published by Elsevier Inc.

Topics

• Academic Medical Centers
• Adult
• Cause of Death
• Chi-Square Distribution
• Cohort Studies
• Databases, Factual
• Disease-Free Survival
• Female
• Follow-Up Studies
• Graft Rejection
• Graft Survival
• Heart Failure (diagnosis, surgery)
• Heart Transplantation (adverse effects, methods)
• Humans
• Kaplan-Meier Estimate
• Kidney Failure, Chronic (etiology, physiopathology, surgery)
• Kidney Transplantation (methods, mortality)
• Male
• Middle Aged
• Retrospective Studies
• Risk Assessment
• Survival Analysis
• United States