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Kidney function in cyclosporine-treated pediatric heart transplant recipients
Insights
Cyclosporine-based triple immunosuppression in pediatric heart transplant recipients supports good kidney function and graft survival. This regimen is compatible with normal glomerular filtration and only minor tubular disturbances post-transplant.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Transplantation Immunology
Background:
- End-stage kidney disease affects 1-3% of cyclosporine-treated heart transplant patients, often with decreased glomerular filtration rate.
- Limited data exist on kidney function in pediatric heart transplant recipients, crucial for their development.
Purpose of the Study:
- To prospectively investigate kidney function in pediatric heart transplant recipients over 18 months.
- To assess the impact of triple immunosuppression on renal parameters.
Main Methods:
- 10 children received triple immunosuppression (cyclosporine, azathioprine, methylprednisolone).
- Kidney function assessed via clearances (51Cr-EDTA, PAH, lithium, sodium), electrolyte measurements, and urinary concentration tests.
- Renal biopsies performed on four patients at 18 months.
Main Results:
- Glomerular filtration rate increased significantly post-transplant and remained stable.
- Renal plasma flow was maintained, and hypertension resolved in most patients.
- Mild hyperuricemia was the most common tubular dysfunction, decreasing over time; no cyclosporine nephrotoxicity diagnosed on biopsy.
Conclusions:
- Triple immunosuppression with cyclosporine effectively prevents acute rejection in pediatric heart transplant recipients.
- This regimen supports normal glomerular function and causes only minor tubular disturbances.
- Kidney function is generally well-preserved in these patients.
Background:
End-stage kidney disease may develop in 1% to 3% of cyclosporine-treated heart transplant recipients, and most patients show a decreased glomerular filtration rate. There are little data on kidney function in pediatric recipients, although good function is needed for their optimal development.
Methods:
Kidney function was prospectively investigated in 10 children receiving triple immunosuppression (cyclosporine, azathioprine, methylprednisolone) during the first 18 months after heart transplantation. The early cyclosporine trough level target was 300 to 500 micrograms/L and 100 to 200 micrograms/L after the first year. 51Chromium-ethylenediamine tetraacetic acid, para-amino hippuric acid, lithium, and sodium clearances, measurements of serum and urinary electrolytes, and urinary concentration tests were performed. Renal biopsy specimens were obtained from four patients after 18 months.
Results:
Heart function was good in all patients. Six patients (60%) remained rejection-free at 18 months. The mean glomerular filtration rate was 92.4 ml/min/1.73 m2 before transplantation, increased to 115 by 6 months (p < 0.05), and thereafter remained stable. The mean renal plasma flow was 487 ml/min/1.73 m2 after 18 months. Hypertension was seen in all patients at discharge but in only one at 18 months. Mild hyperuricemia was the most common sign of tubular dysfunction occurring in five patients at discharge but in only two patients at 18 months. The result of kidney histopathologic study was normal in three of four patients, and cyclosporine nephrotoxicity was not diagnosed.
Conclusions:
Triple immunosuppression with cyclosporine adequately protects the graft against acute rejection. It is compatible with normal glomerular function and leads to only minor tubular disturbances.