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Renal protection strategies after heart transplantation

Daniel Reichart1, Hermann Reichenspurner1, Markus Johannes Barten1

  • 1Department of Cardiovascular Surgery, , University Heart Center Hamburg, Hamburg, Germany.

Clinical Transplantation
|November 20, 2017
PubMed

Insights

Calcineurin inhibitor (CNI) nephrotoxicity is a major cause of kidney dysfunction after heart transplantation. Novel CNI-reducing strategies show promise in minimizing renal damage and improving outcomes.

Area of Science:

  • Nephrology
  • Immunology
  • Cardiology

Background:

  • Calcineurin inhibitor (CNI) nephrotoxicity frequently causes renal dysfunction and mortality post-heart transplantation (HTx).
  • Previous kidney-protecting strategies like CNI minimization or withdrawal often lacked efficacy.

Purpose of the Study:

  • To review recent renal protection strategies in heart transplant recipients.
  • To discuss the efficacy, drawbacks, and optimization of immunosuppressive therapies.

Main Methods:

  • Review of clinical studies investigating novel CNI-reducing immunosuppressive strategies since 2009.
  • Analysis of agents like antithymocyte globulin, sirolimus, everolimus, and mycophenolate.

Main Results:

  • Novel CNI-reducing strategies, utilizing induction agents and alternative immunosuppressants, aim to minimize renal damage.
  • These newer approaches are under investigation for their effectiveness and safety profiles.

Conclusions:

  • Optimizing immunosuppressive therapy is crucial for reducing CNI nephrotoxicity after heart transplantation.
  • Individualized approaches are needed to balance immunosuppression efficacy with renal protection.
Keywords:
calcineurin inhibitorsheart transplantationimmunosuppressionmechanistic target of rapamycin inhibitorsnephrotoxicityrenal protecting strategies

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