NDT Advance Access published online on January 23, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn759
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Chronic kidney disease after heart transplantation
1 Cardiology and Transplantation, The Royal Brompton and Harefield NHS Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex UB8 6JH 2 Nephrology Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS 3 Faculty of Medicine, Imperial College, London, South Kensington Campus, London SW7 2AZ, UK
Correspondence and offprint requests to: Nicholas R. Banner, The Royal Brompton and Harefield NHS Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex UB9 6JH, UK. Tel: +44-1895-828556; Fax: +44-1895-828556; E-mail: n.banner{at}rbht.nhs.uk
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Abstract |
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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.
Keywords: acute renal failure; chronic kidney disease; ciclosporin; heart transplantation; risk factors
Received for publication: 22. 4.08
Accepted in revised form: 18.12.08
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