PMID- 16297783
OWN - NLM
STAT- MEDLINE
DCOM- 20060615
LR  - 20131121
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 24
IP  - 11
DP  - 2005 Nov
TI  - Freedom from graft vessel disease in heart and combined heart- and 
      kidney-transplanted patients treated with tacrolimus-based immunosuppression.
PG  - 1787-92
AB  - BACKGROUND: In end-stage cardiomyopathy where concomitant chronic renal failure 
      is a contraindication for cardiac transplantation (HTx), simultaneous heart and 
      kidney transplantation (HKTx) may be the only feasible therapeutic option. Due to 
      the increased donor shortage, the clinical outcome of combined HKTx patients on 
      tacrolimus-based immunosuppression was assessed and compared with a group of HTx 
      patients. METHODS: Three hundred forty-nine HTxs, including 13 (4%) combined 
      HKTxs, were performed since 1995. Two hundred twenty-one HTx and all HKTx 
      recipients received tacrolimus-based immunosuppression. Acute rejection episodes 
      (AREs), infections, renal function and clinical outcome were evaluated. 
      Pre-operative renal diagnoses for HKTx patients included cystic nephropathy (n = 
      4), glomerulonephritis (n = 4), cytostatica-induced nephropathy (n = 1), chronic 
      rejection after renal transplant (n = 1), reflux nephropathy (n = 2) and chronic 
      calcineurin-inhibitor -induced nephropathy after HTx (n = 1). Twelve patients 
      (92%) were on hemodialysis pre-operatively, 1 underwent implantation of a left 
      ventricular assist device (LVAD) before HKTx. RESULTS: After 4.7 +/- 2 years, 92% 
      of HKTx compared with 85% of HTx patients had survived (p = 0.42). Acute cardiac 
      rejection episodes were more frequent in HTx than in HKTx patients (0.04 +/- 0.09 
      vs 0.02 +/- 0.04 ARE/100 patient-days; p = 0.07). Incidence of infection was 
      comparable (0.3 +/- 0.2 vs 0.5 +/- 0.4 infection/100 patient-days). Freedom from 
      transplant vasculopathy was 100% in the HKTx group compared with 71% in the HTx 
      group after 4 years (p = 0.04). CONCLUSIONS: Tacrolimus-based immunosuppression 
      yields promising long-term results in HKTx and HTx. The incidence of transplant 
      vasculopathy seems to be lower after HKTx than after HTx. If these results are 
      secondary to a protective effect of tacrolimus-induced tolerance or of 
      tolerance-associated co-transplantation they will need to be investigated in 
      prospective multicenter trials.
FAU - Groetzner, Jan
AU  - Groetzner J
AD  - Department of Cardiac Surgery, Ludwig Maximilians University Hospital 
      Grosshadern-Munich, Munich, Germany. jan.groetzner@med.uni-jena.de
FAU - Kaczmarek, Ingo
AU  - Kaczmarek I
FAU - Mueller, Markus
AU  - Mueller M
FAU - Huber, Stefan
AU  - Huber S
FAU - Deutsch, Andre
AU  - Deutsch A
FAU - Daebritz, Sabine
AU  - Daebritz S
FAU - Arbogast, Helmut
AU  - Arbogast H
FAU - Meiser, Bruno
AU  - Meiser B
FAU - Reichart, Bruno
AU  - Reichart B
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
RN  - 0 (Immunosuppressive Agents)
RN  - AYI8EX34EU (Creatinine)
RN  - HU9DX48N0T (Mycophenolic Acid)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - IM
MH  - Cardiomyopathy, Dilated/*epidemiology/*surgery
MH  - Comorbidity
MH  - Coronary Disease/epidemiology
MH  - Creatinine/blood
MH  - Female
MH  - Graft Rejection/epidemiology
MH  - *Heart Transplantation/adverse effects
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Kidney Diseases/*epidemiology/*surgery
MH  - Kidney Failure, Chronic/epidemiology/*surgery
MH  - *Kidney Transplantation/adverse effects
MH  - Male
MH  - Mycophenolic Acid/blood
MH  - Retrospective Studies
MH  - Tacrolimus/therapeutic use
MH  - Treatment Outcome
EDAT- 2005/11/22 09:00
MHDA- 2006/06/16 09:00
CRDT- 2005/11/22 09:00
PHST- 2004/10/18 00:00 [received]
PHST- 2005/03/14 00:00 [revised]
PHST- 2005/03/14 00:00 [accepted]
PHST- 2005/11/22 09:00 [pubmed]
PHST- 2006/06/16 09:00 [medline]
PHST- 2005/11/22 09:00 [entrez]
AID - S1053-2498(05)00196-8 [pii]
AID - 10.1016/j.healun.2005.03.012 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2005 Nov;24(11):1787-92. doi: 
      10.1016/j.healun.2005.03.012.