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Hyperuricemia and gout among heart transplant recipients receiving cyclosporine
D A Burack1, B P Griffith, M E Thompson
1Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania.
Insights
Hyperuricemia and gout are common in heart transplant patients treated with cyclosporine. Gout onset is often accelerated, posing management challenges due to renal issues and medication interactions.
Area of Science:
- Nephrology
- Cardiology
- Rheumatology
Background:
- Cyclosporine is a key immunosuppressant post-transplant.
- Hyperuricemia and gout are potential complications in transplant recipients.
Purpose of the Study:
- To assess the incidence and features of hyperuricemia and gouty arthritis.
- To evaluate these conditions in heart or heart/lung transplant recipients on cyclosporine therapy.
Main Methods:
- Retrospective review of 196 adult transplant recipients' medical records.
- Assessment of peak serum uric acid levels and risk factors.
- Postal questionnaires and follow-up interviews/examinations for gout history.
Main Results:
- Hyperuricemia affected 72% of males and 81% of females.
- Post-transplant gout onset occurred in 8% (definite) and 4% (probable).
- Gout presentation was often accelerated, with polyarticular involvement in 43% of definite cases.
Conclusions:
- Hyperuricemia and gout are frequent in cyclosporine-treated heart transplant patients.
- Gout management is complicated by renal insufficiency and drug interactions.
- The clinical course of gout can be aggressive in this population.
Purpose:
To determine the frequency and characteristics of hyperuricemia and gouty arthritis among cyclosporine-treated heart transplant recipients.
Patients And Methods:
One hundred ninety-six surviving adult heart or heart/lung transplant recipients were evaluated. Medical records were reviewed to determine peak serum uric acid levels after transplantation, and to evaluate potential risk factors for hyperuricemia. Patients were surveyed by postal questionnaire for a history of gouty arthritis, with positive responses evaluated by telephone interview and/or examination of the patient.
Results:
Hyperuricemia occurred in 72% of male and 81% of female patients and was not correlated with cyclosporine level, presence of hypertension, or degree of renal insufficiency. Eleven (6%) patients had gout prior to transplantation; 14 (8%) had onset of definite gout and seven (4%) had probable gout a mean of 17 months after transplantation. Polyarticular arthritis and/or tophi developed in six (43%) of the posttransplant-onset definite gout group within a mean of 31 months.
Conclusion:
Both hyperuricemia and gouty arthritis occur with increased frequency among cyclosporine-treated heart or heart/lung transplant recipients. The clinical course of gout in these patients is often accelerated, with management complicated by the patients' renal insufficiency and interaction with transplant-related medications.