First Experience with Rapamycin-Based Immunosuppression to Improve Kidney Function After Heart Transplantation

“…In some reports, thrombotic lesions were also mentioned (47,50). The more frequent recurrence of TMA with or without hemolytic uremic syndrome under cyclosporine has always been a matter of concern after renal transplantation (30,31,39,51 (60)(61)(62)(63)(64)(65), even after the higher nephrotoxicity of this combination was evident (66)(67)(68)(69)(70). After renal transplantation as well a high incidence of TMA under CNI combined with mTOR-inhibitor was observed (71,72 …”

Section: However Even the High Number Of Biopsies In This Report Doementioning

confidence: 99%

Biopsy‐Diagnosed Renal Disease in Patients After Transplantation of Other Organs and Tissues

Schwarz¹,

Haller²,

Schmitt³

et al. 2010

American Journal of Transplantation

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Renal function deteriorates in about half of patients undergoing other transplants. We report the results of 105 renal biopsies from 101 nonrenal transplant recipients (bone marrow 14, liver 41, lung 30, heart 20). Biopsy indications were protracted acute renal failure (9%), creatinine increases (83%), heavy proteinuria (22%), or renal insufficiency before re-transplantation (9%). Histological findings other than nonspecific chronic changes, hypertension-related damage, and signs of chronic CNI toxicity included primary glomerular disease (17%), mostly after liver transplantation (21%) or after bone marrow transplantation (29%), and thrombotic microangiopathy (TMA) namely (10%). TMA had the most serious impact on the clinical course. Besides severe hypertension, one TMA patient died of cerebral hemorrhage, 5 had hemolyticuremic syndrome, and 6 rapidly developed end-stage renal failure. TMA patients had the shortest kidney survival post-biopsy and, together with patients with acute tubular injury, the shortest kidney and patient survival since transplantation. Nine TMA patients had received CNI, 3 of them concomitantly received an mTOR-inhibitor. CNI toxicity is implicated in most patients with renal failure after transplant of other organs and may play a role in the development of TMA, the most serious complication. However, decreased renal function should not be routinely ascribed to CNI.

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“…89,90 As opposed to a CNI-minimization approach, several retrospective studies in nonrenal organ recipients have investigated conversion to sirolimus as part of a CNI-withdrawal strategy to protect renal function. Results have generally been conflicting with both CsA [91][92][93][94] and tacrolimus. 95 Ongoing, prospective clinical trials should establish whether conversion to sirolimus preserves kidney function and whether level of kidney function at the time of conversion determines the utility of this strategy.…”

Section: Cni-sparing Therapy With Mycophenolate Mofetil or Sirolimusmentioning

confidence: 99%

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Bloom

Reese

2007

Journal of the American Society of Nephrology

164

138

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First Experience with Rapamycin-Based Immunosuppression to Improve Kidney Function After Heart Transplantation

Abstract: We conclude that transplant patients with impaired kidney function will have an immediate benefit from partially replacing calcineurin inhibitors by rapamycin.

Cited by 35 publications

References 9 publications

The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients

The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients

Biopsy‐Diagnosed Renal Disease in Patients After Transplantation of Other Organs and Tissues

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

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