Histopathology of renal failure after heart transplantation: A diverse spectrum

Pinney, Sean; Balakrishnan, Revathi; Dikman, Steven; Nair, Ajith; Hammond, Kimmarie; Domanski, Michael J.; Anyanwu, Anelechi C.; DeBoccardo, Graciela

doi:10.1016/j.healun.2011.08.012

Cited by 22 publications

(10 citation statements)

References 15 publications

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“…A potential justification is that neither doses nor trough levels correlate perfectly with real CNI exposure, especially in the case of cyclosporine . In addition, recent data suggest that the role of direct CNI toxicity in postheart transplant renal dysfunction might be overestimated in some instances .…”

Section: Discussionmentioning

confidence: 99%

Long-term evolution, secular trends, and risk factors of renal dysfunction following cardiac transplantation

et al. 2014

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SummaryRecent reports suggest that individuals who underwent heart transplantation in the last decade have improved post-transplant kidney function. The objectives of this retrospective study were to describe the incidence and to identify fixed and time-dependent predictors of renal dysfunction in cardiac recipients transplanted over a 25-year period (1983-2008). To illustrate temporal trends, patients (n = 306) were divided into five groups based on year of transplantation. The primary endpoint was the estimated glomerular filtration rate (eGFR) at year 1. Secondary endpoints were time to moderate (eGFR <60 ml/min/1.73 m 2 ) and severe renal dysfunction (eGFR <30 ml/min/1.73 m 2 ). Risk factor analyses relied on multivariable regression models. Kidney function was mildly impaired before transplant (median eGFR=61.0 ml/min/1.73 m 2 ), improved at discharge (eGFR=72.3 ml/min/1.73 m 2 ; P < 0.001), decreased considerably in the first year (eGFR = 54.7 ml/min/1.73 m 2 ; P < 0.001), and deteriorated less rapidly thereafter. At year 1, 2004-2008 recipients exhibited a higher eGFR compared with all other patients (P < 0.001). Factors independently associated with eGFR at year 1 and with moderate and severe renal dysfunction included age, gender, pretransplant eGFR, blood pressure, glycemia, and use of prednisone (P < 0.05). In summary, kidney function worsens constantly up to two decades after cardiac transplantation, with the greatest decline occurring in the first year. Corticosteroid minimization and treatment of modifiable risk factors (hypertension, diabetes) may minimize renal deterioration.

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Section: Discussionmentioning

confidence: 99%

Long-term evolution, secular trends, and risk factors of renal dysfunction following cardiac transplantation

et al. 2014

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“…severe bleeding). Results from kidney biopsies after transplantation revealed a diverse spectrum (18,32) and histological lesions attributed for CNI nephrotoxicity seem not to be specific as recent work suggests (33). Therefore, additional guiding parameters beside eGFR, biopsy and invasive measurements of renal function are required.…”

Section: Discussionmentioning

confidence: 99%

Renal Comorbidity After Solid Organ and Stem Cell Transplantation

Clajus

Hanke

Gottlieb

et al. 2012

American Journal of Transplantation

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“…Other associated medical conditions, such as hypertension [ 8 , 17 , 30 , 57 ], diabetes [ 8 , 58 , 59 ] and hyperlipidaemia, may contribute to on-going renal dysfunction and add to the cumulative burden of renal insufficiency in the post-transplant phase.…”

Section: Timing/pathophysiology/mechanisms Of Kidney Injurymentioning

confidence: 99%

Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children

Hoskote

Burch

2014

Pediatr Nephrol

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Significant advances in cardiac intensive care including extracorporeal life support have enabled children with complex congenital heart disease and end-stage heart failure to be supported while awaiting transplantation. With an increasing number of survivors after heart transplantation in children, the complications from long-term immunosuppression, including renal insufficiency, are becoming more apparent. Severe renal dysfunction after heart transplant is defined by a serum creatinine level >2.5 mg/dL (221 μmol/L), and/or need for dialysis or renal transplant. The degree of renal dysfunction is variable and is progressive over time. About 3–10 % of heart transplant recipients will go on to develop severe renal dysfunction within the first 10 years post-transplantation. Multiple risk factors for chronic kidney disease post-transplant have been identified, which include pre-transplant worsening renal function, recipient demographics and morbidity, peri-transplant haemodynamics and long-term exposure to calcineurin inhibitors. Renal insufficiency increases the risk of post-transplant morbidity and mortality. Hence, screening for renal dysfunction pre-, peri- and post-transplantation is important. Early and timely detection of renal insufficiency may help minimize renal insults, and allow prompt implementation of renoprotective strategies. Close monitoring and pre-emptive management of renal dysfunction is an integral aspect of peri-transplant and subsequent post-transplant long-term care.

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Histopathology of renal failure after heart transplantation: A diverse spectrum

Cited by 22 publications

References 15 publications

Long-term evolution, secular trends, and risk factors of renal dysfunction following cardiac transplantation

Long-term evolution, secular trends, and risk factors of renal dysfunction following cardiac transplantation

Renal Comorbidity After Solid Organ and Stem Cell Transplantation

Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children

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