End-stage renal disease after orthotopic heart transplantation: A single-institute experience
Journal
Transplantation Proceedings
Journal Volume
42
Journal Issue
3
Pages
948-951
Date Issued
2010
Author(s)
CHIH-HSIEN WANGvvv
Tsao C.I.
Ko W.J.
Abstract
Orthotopic heart transplantation is the treatment of choice for end-stage heart failure, and calcineurin inhibitor agents allow for better allograft survival. However, pretransplantation low cardiac output status and posttransplantation immunosuppressants contribute toward deterioration of renal function. From 1987 to 2008, 350 patients underwent orthotopic heart transplantation in our hospital. Most of them received anti-thymocyte globulin (ATG) as the induction immunosuppressant. The introduction of mycophenolate mofetil (MMF) reduced the maintenance level of cyclosporine. The 26 patients who developed end-stage renal disease required dialysis. We reviewed the patient characteristics, including pretransplantation status, immunosuppressant regimens and drug levels, time and type of dialysis, and mortality rate. The mean age of these 26 patients was 53 years. Three patients underwent peritoneal dialysis. The overall 1-year survival rate was 96%, and the 5-year survival rate was 80%. The duration from heart transplantation to chronic dialysis correlated with the presence of a pretransplantation diagnosis of diabetes (P <.05) and an elevated pretransplantation blood creatinine level (P =.01), but there was no significant effect of the initial level of cyclosporine. In addition, the pretransplantation blood creatinine level was also related to the necessity of immediate postoperative hemodialysis (P =.01). There was no significant risk factor in relation to mortality. Regardless of modification of immunosuppressant regimens and initial drug levels, pretransplantation kidney function played an important inverse role in the duration from transplantation to dialysis: the higher the pretransplantation blood creatinine, the shorter the duration. While awaiting a heart transplant, more effort should be spent on protecting renal function to avoid early chronic dialysis. ? 2010 Elsevier Inc.
SDGs
Other Subjects
immunosuppressive agent; lymphocyte antibody; adult; aged; article; chronic kidney failure; drug combination; female; heart output; heart transplantation; human; immunology; male; middle aged; mortality; peritoneal dialysis; renal replacement therapy; retrospective study; Adult; Aged; Antilymphocyte Serum; Cardiac Output; Drug Therapy, Combination; Female; Heart Transplantation; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis; Renal Dialysis; Retrospective Studies
Type
conference paper