PMID- 19168463
OWN - NLM
STAT- MEDLINE
DCOM- 20090803
LR  - 20220321
IS  - 1460-2385 (Electronic)
IS  - 0931-0509 (Linking)
VI  - 24
IP  - 5
DP  - 2009 May
TI  - Chronic kidney disease after heart transplantation.
PG  - 1655-62
LID - 10.1093/ndt/gfn759 [doi]
AB  - BACKGROUND: Chronic kidney disease (CKD) is a complication of heart 
      transplantation related to calcineurin inhibitor nephrotoxicity. However, it is 
      unclear whether early ciclosporin (CsA) exposure influences CKD in the long term. 
      METHODS: We analysed risk factors for CKD in 352 patients who underwent 
      orthotopic heart transplantation (1995-2005). In 2000, we reduced our target CsA 
      levels in the first year after transplantation. RESULTS: Actuarial patient 
      survival was 79% at 1 year and 62% at 10 years. Estimated median glomerular 
      filtration rate (eGFR) by the four-variable Modification of Diet in Renal Disease 
      formula was 64 ml/min/1.73 m2 before transplantation, inter-quartile range (IQR) 
      54-78. After transplantation, the eGFR was 48 (IQR 37-61) at Year 1, and 
      41(35-57) at Year 10. The cumulative probability of eGFR <45 ml/min/1.73 m2 was 
      45% at Year 1, 71% at Year 5 and 83% at Year 10. A multivariable logistic 
      regression model was constructed for the development of eGFR <45 ml/min/1.73 m2 
      by 3 years. The risk factors were post-operative renal replacement therapy for 
      acute renal failure (ARF), P < 0.001; pretransplant diabetes, P = 0.005; 
      increasing recipient age, P < 0.001; female recipient, P = 0.029; female donor, P 
      = 0.04, but not CsA regimen. The cumulative probability of developing stage 5 CKD 
      (eGFR <15) was 3% at Year 5 and 12% at Year 10. Although lower ciclosporin 
      initial levels were associated with less renal dysfunction at Year 1 (P = 0.008), 
      there was no significant effect by Year 3 (P = 0.7). CONCLUSION: The incidence of 
      CKD increased with time and was not influenced by the CsA regimen. Some risk 
      factors are not modifiable but measures to reduce the incidence of post-operative 
      ARF may help to reduce CKD.
FAU - Hamour, Iman M
AU  - Hamour IM
AD  - Cardiology and Transplantation, The Royal Brompton and Harefield NHS Trust, 
      Harefield Hospital, Hill End Road, Harefield, Middlesex UB8 6JH, UK.
FAU - Omar, Fazir
AU  - Omar F
FAU - Lyster, Haifa S
AU  - Lyster HS
FAU - Palmer, Andrew
AU  - Palmer A
FAU - Banner, Nicholas R
AU  - Banner NR
LA  - eng
PT  - Journal Article
DEP - 20090123
PL  - England
TA  - Nephrol Dial Transplant
JT  - Nephrology, dialysis, transplantation : official publication of the European 
      Dialysis and Transplant Association - European Renal Association
JID - 8706402
RN  - 0 (Immunosuppressive Agents)
RN  - 83HN0GTJ6D (Cyclosporine)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Chronic Disease
MH  - Cyclosporine/*adverse effects/therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Graft Rejection/immunology/prevention & control
MH  - Heart Transplantation/*adverse effects/immunology
MH  - Humans
MH  - Immunosuppressive Agents/*adverse effects/therapeutic use
MH  - Kidney Diseases/*epidemiology
MH  - Kidney Failure, Chronic/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Young Adult
EDAT- 2009/01/27 09:00
MHDA- 2009/08/04 09:00
CRDT- 2009/01/27 09:00
PHST- 2009/01/27 09:00 [entrez]
PHST- 2009/01/27 09:00 [pubmed]
PHST- 2009/08/04 09:00 [medline]
AID - gfn759 [pii]
AID - 10.1093/ndt/gfn759 [doi]
PST - ppublish
SO  - Nephrol Dial Transplant. 2009 May;24(5):1655-62. doi: 10.1093/ndt/gfn759. Epub 
      2009 Jan 23.