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

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

Research output: Contribution to journalArticlepeer-review

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
Pages (from-to)297-304
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume36
Issue number3
DOIs
StatePublished - 1 Mar 2017
Externally publishedYes

Keywords

  • calcineurin inhibitor
  • heart transplantation
  • kidney transplantation
  • renal failure

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