Kidney transplantation as a therapeutic option for end-stage renal disease developing after heart transplantation

Avishay Grupper, Ayelet Grupper, Richard C. Daly, Naveen Luke Pereira, Matthew A. Hathcock, Walter K Kremers, Fernando G Cosio, Brooks Sayre Edwards, Sudhir S. Kushwaha

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Progressive renal failure is a frequent complication after heart transplantation (HTx). It may result in end-stage renal disease (ESRD), prompting consideration of kidney Tx after HTx (KAH). Methods: We performed a retrospective single-center study of 268 HTx recipients to evaluate outcomes after KAH compared with HTx recipients with and without ESRD. Results: During a median follow-up of 76 months, ESRD developed in 51 patients (19), and 39 of them (76%) underwent KAH. The mean time from HTx to ESRD was 83 months. The incidence of switching to a calcineurin inhibitor (CNI)-free regimen based on sirolimus was significantly lower among recipients with ESRD (6% vs 57%, . p = 0.0001), and prolonged exposure to CNI significantly increased the risk for ESRD (hazard ratio, 1.09; 95% confidence interval, 1.03-1.15; . p < 0.005). Death-censored renal graft survival after KAH was 95%, 95%, and 83% at 1, 5, and 10 years, respectively. Median long-term survival of KAH patients was comparable to HTx recipients without ESRD (17.5 vs 17.1 years, . p = 0.27) and significantly better compared with HTx recipients with ESRD (17.5 vs 7.3 years, . p < 0.001). Conclusions: Prolonged exposure to CNI immunosuppression medications significantly increases the risk for ESRD among HTx recipients. KAH is a good therapeutic option for HTx recipients with ESRD, with survival benefit comparable to HTx without ESRD.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - 2016

Fingerprint

Heart Transplantation
Kidney Transplantation
Chronic Kidney Failure
Kidney
Therapeutics
Survival
Graft Survival
Sirolimus
Immunosuppression
Renal Insufficiency
Confidence Intervals

Keywords

  • Calcineurin inhibitor
  • Heart transplantation
  • Kidney transplantation
  • Renal failure

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Kidney transplantation as a therapeutic option for end-stage renal disease developing after heart transplantation. / Grupper, Avishay; Grupper, Ayelet; Daly, Richard C.; Pereira, Naveen Luke; Hathcock, Matthew A.; Kremers, Walter K; Cosio, Fernando G; Edwards, Brooks Sayre; Kushwaha, Sudhir S.

In: Journal of Heart and Lung Transplantation, 2016.

Research output: Contribution to journalArticle

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abstract = "Background: Progressive renal failure is a frequent complication after heart transplantation (HTx). It may result in end-stage renal disease (ESRD), prompting consideration of kidney Tx after HTx (KAH). Methods: We performed a retrospective single-center study of 268 HTx recipients to evaluate outcomes after KAH compared with HTx recipients with and without ESRD. Results: During a median follow-up of 76 months, ESRD developed in 51 patients (19), and 39 of them (76{\%}) underwent KAH. The mean time from HTx to ESRD was 83 months. The incidence of switching to a calcineurin inhibitor (CNI)-free regimen based on sirolimus was significantly lower among recipients with ESRD (6{\%} vs 57{\%}, . p = 0.0001), and prolonged exposure to CNI significantly increased the risk for ESRD (hazard ratio, 1.09; 95{\%} confidence interval, 1.03-1.15; . p < 0.005). Death-censored renal graft survival after KAH was 95{\%}, 95{\%}, and 83{\%} at 1, 5, and 10 years, respectively. Median long-term survival of KAH patients was comparable to HTx recipients without ESRD (17.5 vs 17.1 years, . p = 0.27) and significantly better compared with HTx recipients with ESRD (17.5 vs 7.3 years, . p < 0.001). Conclusions: Prolonged exposure to CNI immunosuppression medications significantly increases the risk for ESRD among HTx recipients. KAH is a good therapeutic option for HTx recipients with ESRD, with survival benefit comparable to HTx without ESRD.",
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AU - Grupper, Avishay

AU - Grupper, Ayelet

AU - Daly, Richard C.

AU - Pereira, Naveen Luke

AU - Hathcock, Matthew A.

AU - Kremers, Walter K

AU - Cosio, Fernando G

AU - Edwards, Brooks Sayre

AU - Kushwaha, Sudhir S.

PY - 2016

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N2 - Background: Progressive renal failure is a frequent complication after heart transplantation (HTx). It may result in end-stage renal disease (ESRD), prompting consideration of kidney Tx after HTx (KAH). Methods: We performed a retrospective single-center study of 268 HTx recipients to evaluate outcomes after KAH compared with HTx recipients with and without ESRD. Results: During a median follow-up of 76 months, ESRD developed in 51 patients (19), and 39 of them (76%) underwent KAH. The mean time from HTx to ESRD was 83 months. The incidence of switching to a calcineurin inhibitor (CNI)-free regimen based on sirolimus was significantly lower among recipients with ESRD (6% vs 57%, . p = 0.0001), and prolonged exposure to CNI significantly increased the risk for ESRD (hazard ratio, 1.09; 95% confidence interval, 1.03-1.15; . p < 0.005). Death-censored renal graft survival after KAH was 95%, 95%, and 83% at 1, 5, and 10 years, respectively. Median long-term survival of KAH patients was comparable to HTx recipients without ESRD (17.5 vs 17.1 years, . p = 0.27) and significantly better compared with HTx recipients with ESRD (17.5 vs 7.3 years, . p < 0.001). Conclusions: Prolonged exposure to CNI immunosuppression medications significantly increases the risk for ESRD among HTx recipients. KAH is a good therapeutic option for HTx recipients with ESRD, with survival benefit comparable to HTx without ESRD.

AB - Background: Progressive renal failure is a frequent complication after heart transplantation (HTx). It may result in end-stage renal disease (ESRD), prompting consideration of kidney Tx after HTx (KAH). Methods: We performed a retrospective single-center study of 268 HTx recipients to evaluate outcomes after KAH compared with HTx recipients with and without ESRD. Results: During a median follow-up of 76 months, ESRD developed in 51 patients (19), and 39 of them (76%) underwent KAH. The mean time from HTx to ESRD was 83 months. The incidence of switching to a calcineurin inhibitor (CNI)-free regimen based on sirolimus was significantly lower among recipients with ESRD (6% vs 57%, . p = 0.0001), and prolonged exposure to CNI significantly increased the risk for ESRD (hazard ratio, 1.09; 95% confidence interval, 1.03-1.15; . p < 0.005). Death-censored renal graft survival after KAH was 95%, 95%, and 83% at 1, 5, and 10 years, respectively. Median long-term survival of KAH patients was comparable to HTx recipients without ESRD (17.5 vs 17.1 years, . p = 0.27) and significantly better compared with HTx recipients with ESRD (17.5 vs 7.3 years, . p < 0.001). Conclusions: Prolonged exposure to CNI immunosuppression medications significantly increases the risk for ESRD among HTx recipients. KAH is a good therapeutic option for HTx recipients with ESRD, with survival benefit comparable to HTx without ESRD.

KW - Calcineurin inhibitor

KW - Heart transplantation

KW - Kidney transplantation

KW - Renal failure

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