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Dr. Adrian Man
Chronic kidney disease after treatment with cyclosporine or tacrolimus in heart transplant recipients – experience of a Romanian medical center Mihaela Ispas, Carmen Chincişan, Septimiu Voidăzan, Alina Mărginean, Minodora Dobreanu
Abstract: Renal failure is a complication with prognostic implications in transplant recipients. The aims of our study were to describe renal dysfunction occurring on calcineurin-inhibitor therapies in recipients who under-went heart transplantation at Târgu Mures Cardiovascular Institute between November 1999 and February 2011 and to identify risk factors for decline in renal function. We studied the evolution of renal function in 35 heart transplant recipients in relation to: immunosuppressive therapy (cyclosporine or tacrolimus), gender, age at the time of transplantation, time elapsed after transplantation, diabetes and hypertension. Changes in glomerular filtration rate (GFR) and proportion of patients with a decline in GFR to < 30 ml/min/1.73m2 from baseline, were analysed at 1, 3, 6 months, and yearly thereafter. Serum creatinine gradually increased post-transplantation in all the recipients; GFR showed a significant decrease from baseline (one month after transplantation) until to fifth year of monitoring, the most significant decrease occurring from one to six months after surgery. After the acute post-transplantation period, heart transplant recipients given long-term treatment with calcineurin-inhibitors experienced only small changes in GFR over time. There were no significant differences in outcome of recipients receiving cyclosporine and those with tacrolimus. Significant chronic decrease in kidney function occurred in 25% of our patients treated with tacrolimus and in 20% of the patients treated with cyclosporine. Increased age at the time of transplantation, the time elapsed since transplant, baseline GFR, hypertension and diabetes mellitus were identified as predictors of renal dysfunction in heart transplanted patients. Survival at five years was similar for the group immunosuppressed with cyclosporine comparative with the group treated with tacrolimus. Conclusion: Treatment with calcineurin inhibitors in heart transplanted recipients is associated with chronic kidney damage. We found a significant decrease of renal function already at six months post transplant, in both immunosuppressive treatments. Keywords: heart transplant,post-transplantation renal failure, calcineurin-inhibitors |
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Ispas M, Chincişan C, Voidăzan S, Mărginean A, Dobreanu M. Chronic kidney disease after treatment with cyclosporine or tacrolimus in heart transplant recipients – experience of a Romanian medical center. Rev Romana Med Lab. 2012;20(2):117-25
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