Nephrology Dialysis Transplantation, Vol 13, Issue 11 2905-2908, Copyright © 1998 by Oxford University Press
L Frimat, J Villemot, L Cormier, T Cao-Huu, E Renoult, D Hestin, C Dopff, S Mattei, J Hubert and M Kessler
Background: Five to 10% of heart-transplant recipients
develop end-stage renal failure (ESRF). Little is known about the outcome
of these patients under renal replacement therapy.
Methods: We conducted a retrospective study in 16 men
(mean age 52.8±7.4 years at heart transplantation) who developed
ESRF 5.3±2.1 years later. Results:
Haemodialysis (HD) was the first-line treatment (mean Kt/V
135±0.4). Vascular access was unsuccessful in six patients
(37.5%) due to peripheral arteriopathy and they were treated with tunnelled
catheters for an average 15 months without bacterial infection. Mean weight
was 68.4±10 kg at onset of HD and 61.7±9 kg one month
later. Despite this reduction in extracellular overload one
antihypertensive drug was required in 75% of patients and two drugs in
12.5%. One patient tolerated automated peritoneal dialysis (PD) for 16
months (weekly Kt/V 2.1) despite persistent anuria. Renal transplantation
(RT) was contraindicated in eight patients because of aortoliac
arteriopathy (n=5), poor general status (n=2), or ischaemic heart disease
(n=1). RT was performed in eight patients with no acute episode of heart or
renal graft rejection. There were no serious infectious complications.
Three months after RT, mean serum creatinine was 115 &mgr;mol/l. One
patient developed post-transplant lymphoproliferative disorder 3.5 months
after RT and was successfully treated with transplant nephrectomy. Sudden
death occurred in two patients 18 and 33 months after RT. Overall patient
survival was 100, 78, and 59%, 1, 2 and 3 years after HD onset
respectively. Using a time-dependent variable, the Cox model analysis
demonstrated that heart-transplant recipients with ESRF have a relative
risk of death 3.2 times higher than those without ESRF (95% CI=1.3-7.8).
Conclusions: HD, PD, and RT can be useful for the
treatment of ESRF after heart transplantation. After initiating HD, patient
survival is nearly the same as that reported in patients in Europe
undergoing HD for other causes. But ESRF seems to reduce life expectancy in
heart-transplant recipients. Key words: end-stage
renal failure; heart transplantation haemodialysis; peritoneal dialysis;
renal transplantation
ORIGINAL ARTICLES
Treatment of end-stage renal failure after heart transplantation
Departments of Nephrology, Heart Transplantation, and Urology, University Hospital, Nancy, France; Corresponding author at: Service de Néphrologie, Hôpitaux de Brabois, Vandoeuvre-les-Nancy 54500, France
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