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

Avishay Grupper1, Ayelet Grupper2, Richard C Daly3

  • 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|September 20, 2016
PubMed

Insights

Kidney transplantation after heart transplantation (KAH) offers a survival benefit for heart transplant recipients who develop end-stage renal disease (ESRD). Prolonged calcineurin inhibitor (CNI) use increases ESRD risk.

Area of Science:

  • Nephrology
  • Cardiology
  • Transplantation Immunology

Background:

  • Progressive renal failure is a common complication post-heart transplantation (HTx).
  • End-stage renal disease (ESRD) may necessitate kidney transplantation after heart transplantation (KAH).

Purpose of the Study:

  • To evaluate outcomes of KAH in HTx recipients.
  • To compare KAH outcomes with HTx recipients who have or do not have ESRD.

Main Methods:

  • Retrospective single-center study.
  • Involved 268 HTx recipients.
  • Compared outcomes for KAH, HTx with ESRD, and HTx without ESRD.

Main Results:

  • ESRD developed in 19% of HTx recipients; 76% underwent KAH.
  • Prolonged calcineurin inhibitor (CNI) exposure significantly increased ESRD risk (HR 1.09).
  • Death-censored renal graft survival after KAH was high (95% at 1 year, 83% at 10 years).

Conclusions:

  • Prolonged CNI immunosuppression is a significant risk factor for ESRD in HTx recipients.
  • KAH provides a survival benefit for HTx recipients with ESRD, comparable to those without ESRD.
Abstract

Keywords:
calcineurin inhibitorheart transplantationkidney transplantationrenal failure

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