Renal Transplantli Hastada Açık Kalp Cerrahisi

Nephrology Dialysis Transplantation, 1998

introduction of cyclosporin as an immunosuppressive agent has made cardiac transplantation a viable option Background. In Rotterdam 304 heart transplants have been performed since 1984. End-stage renal failure, in end-stage heart failure. Patient survival rates of 50% at 10 years are now achieved and in general the quality necessitating renal replacement therapy, has developed in 24 patients (8%) after an interval of 25-121 months of life during these years is excellent. An inevitable (median 79 months). After starting renal replacement consequence of improved survival is that an increasing therapy one-year survival was only 60%. Overall surnumber of patients is faced with the long-term comvival after heart transplantation, however, was favourplications of transplantation [1]. The three most able: 5 and 10 year survival rates of 79% and 50% important complications are: development of coronary respectively. artery disease, an increased risk of malignancy and Methods. A case-control study was performed to progressive renal dysfunction as a result of cyclosporin identify possible risk factors in cases who went on to [2]. In contrast to acute cyclosporin nephrotoxicity develop end-stage renal failure compared to controls. which is usually reversible, chronic cyclosporin nephro-Results. We found that renal failure was not limited toxicity is accompanied by pronounced anatomical to elderly patients with ischaemic heart disease, but changes, such as interstitial fibrosis, tubular atrophy also occurred in young patients having dilated cardiand arteriolar hyalinosis [3,4], and is not reversible omyopathy. A significant rise in the serum creatinine [5,6 ]. The pathogenesis of chronic cyclosporin nephrowas found in cases compared to controls as early as 3 toxicity is unclear [7]. What is clear is that 2 years months after transplantation. Cyclosporin dose and after heart transplantation renal function is moderately trough levels were not different between cases and impaired (serum creatinine >150 mmol/l ) in half of controls. Neither were there differences in the use of the patients, and that severe renal impairment (serum calcium-antagonists or other antihypertensive drugs, creatinine >250 mmol/l ) occurs in more than 10% of allopurinol or diuretics. Rejection incidence was also these patients after 4 years [8]. Most heart transplant similar between the two groups.

Renal failure, 2015

Cardiovascular diseases are the major cause of morbidity and mortality in renal transplant recipients. We report our experience in the treatment of patients with renal allograft who required cardiovascular surgery. Indications for cardiovascular surgery, postoperative complications, and outcome were recorded in a cohort of renal transplant recipients. Thirteen patients, five female and eight male, aged from 46 to 75 years underwent cardiac surgery after renal transplantation at University Hospital Centre Zagreb. Isolated coronary artery bypass grafting (CABG) was performed in five patients, valve replacement in six patients, reconstruction of ascending aorta, and aortic arch in one patient as well as the extraction of tumor formation from the heart. Three patients had simultaneous CABG and valve replacement. Four patients (31%) required acute hemodialysis after the surgery and two of them continued with dialysis after discharge. Postoperative course was complicated with infections o...

Revista Argentina de Cardiologia

The aim of this update is to highlight the relationship between the heart and the kidney throughout the entire journey involved in heart transplantation. Faced with heart transplantation, the cardiovascular and renal systems behave as mates of a journey that, at times, is difficult to determine when it starts, and that forces them to overcome different obstacles, such as hemodynamic changes, neuro-humoral and inflammatory response, surgical injury, immune reaction, and drug toxicity. This relationship can be seen as an adventure that they must inevitably share. We will try to accompany both organs in this journey, but paying special attention to the kidney, and to describe the associations and protection and damage mechanisms generated throughout its course. In this journey we can recognize solidarity responses to maintain the balance between both systems, but in this attempt to protect, collateral injury occurs.

Clinical Transplantation, 2005

Abstract: Background: The outcome of solid organ transplantation has dramatically improved after the introduction of the calcineurin inhibitor cyclosporine. With the increasing longevity of heart transplant recipients, the long-term effects of cyclosporine on renal function have become more evident. The natural history of kidney function following orthotopic heart transplant is not well defined and long-term follow up studies are scant.Methods: We conducted an observational study on patients who received a heart transplant at Saint Louis University Hospital between January 1, 1983 and December 31, 1988. Patients were followed up for 15 yr or until death whichever occurred first. In order to assess the effect of heart transplantation and cyclosporine exposure on long-term renal function we restricted the statistical analysis to patients who survived the first year post-transplantation.Results: A total of 68 patients received orthotopic heart transplants at Saint Louis University Hospital between 1983 and 1988. Forty-eight (71%) patients survived for more than 1 yr. All patients were treated with cyclosporine based triple immunosuppressive regimen, with gradual cyclosporine dose reduction over time. The mean duration of follow-up was 8 yr. The estimated GFR at 5 and 10 yr post-transplant were significantly lower than estimated GFR at baseline and 1 yr post-transplant. There was no significant difference between estimated GFR at 15 yr and estimated GFR at baseline or 1 yr post-transplant. The cumulative incidence of chronic renal failure (GFR ≤ 29 mL/min/1.73 m2) at 5, 10 and 15 yr was 4.2, 10.4 and 12.5%, respectively (p < 0.05). The cumulative incidence of severe chronic renal failure (GFR ≤ 15 mL/min/1.73 m2) at 5, 10 and 15 yr was 2.1, 8.3 and 8.3%, respectively. The mortality rate was 8, 37, and 52% at 5, 10, and 15 yr, respectively. The 10 and 15 yr survivors had an estimated GFR at 1 yr post-transplant that was significantly higher than the non-survivors. Age, pre-transplantation estimated GFR, pre-transplantation diabetes and pre-transplantation hypertension are risk factors associated with ≥10 mL/min/1.73 m2 decrement in estimated GFR.Conclusion: Heart transplant survivors beyond the first year post-transplant have a significant decrease in renal function and significant mortality observed over time. Age, pre-transplant GFR, pre-transplant diabetes and pre-transplant hypertension are important risk factors for decrement in renal function.

Transplantation Proceedings, 2007

Objective. Renal failure after cardiac transplantation is a common and serious complication. In this study we investigated the incidence and effects of renal failure on survival among patients who underwent cardiac transplantation. Patients. Eight patients underwent cardiac and one patient combined cardiac and renal transplantation. The mean age of the patients was 33 Ϯ 11.6 years (range, 17 to 51). On preoperative echocardiographic evaluation, the mean ejection fraction was calculated as 19 Ϯ 3.11% (range, 16% to 24%). One patient had compensated renal failure and one patient, dialysis-dependent renal failure. Hemofiltration was routinely used during the operations. Corticosteroids, cyclosporine, and mycophenolate mofetil were used for immunosuppression. Early renal replacement therapy was performed in patients with acute renal failure. Results. The incidence of acute renal failure was 55.5% (5 patients). In the early postoperative and follow-up periods, the mean ejection fraction was 55 Ϯ 9.9% and 57 Ϯ 4.5%, respectively. The mean follow-up period was 21.3 Ϯ 8.8 (range, 6 to 33) months. In the early initiation period, the mean peak value of cyclosporine blood level was 479 Ϯ 201.8 ng/mL during the first month, 250 Ϯ 95.3 and after the third month, 195 Ϯ 43.7 ng/mL. The mean creatinine level at last follow-up was 1.27 Ϯ 0.4. One patient experienced a grade III-A rejection episode. One patient died due to coronary artery occlusive disease at 31 months after transplantation. Comment. In our study we have observed that renal failure had no negative effect on patient survival. This can be explained by improved cardiac performance, keeping cyclosporine levels low finding and utilizing early renal replacement treatment.

Journal of the American Society of Nephrology, 2003

Renal insufficiency has been identified as a risk factor for graft loss and death after renal transplantation but has not been consistently linked to early, nonfatal, hospitalized heart disease (HHD). With the United States Renal Data System database, 29,597 patients who received a kidney transplant between January 1, 1996, and July 31, 2000, with Medicare as the primary payer, and were monitored until December 31, 2000, were studied. Cox proportional-hazards regression models were used to calculate the association of recipient estimated GFR (eGFR) at 1 yr after renal transplantation, as determined with the Modification of Diet in Renal Disease formula, with hospitalization for treatment of acute coronary syndromes (ACS) (International Classification of Diseases, version 9, code 410.x or 411.x) or congestive heart failure (CHF) (code 428.x) 1 to 3 yr after renal transplantation. Rates of ACS and CHF were 2.2 and 4.9%, respectively, for patients with eGFR of Ͻ44.8 ml/min per 1.73 m 2 , compared with 1.2 and 1.4% for patients with eGFR of Ͼ69.7 ml/min per 1.73 m 2. Reduced eGFR (Ͻ44.8 ml/min per 1.73 m 2 , compared with Ͼ69.7 ml/min per 1.73 m 2) at the end of the first 1 yr after transplantation was independently associated with increased risks of both ACS (adjusted hazard ratio, 2.16; 95% confidence interval, 1.39 to 3.35) and CHF (adjusted hazard ratio, 2.95; 95% confidence interval, 2.24 to 3.90). It was concluded that early renal insufficiency (approximately stage 3 chronic kidney disease) was associated with higher rates of HHD 1 to 3 yr after kidney transplantation. Preservation of renal function after renal transplantation may reduce the rates of HHD, and renal transplant recipients with reduced eGFR should be considered at high risk of developing cardiovascular disease.

Transplantation Proceedings, 2003

Transplantation Proceedings, 2003

Background. Renal dysfunction is a common complication after orthotopic heart transplantation (HT). The importance of factors other than exposure to immunosuppressive drugs is unclear. The purpose of this study was to determine the incidence and natural history of renal dysfunction following heart transplantation, and to evaluate a number of variables as risk factors for this condition.

Transplantation Proceedings

Journal of Heart and Lung Transplantation, 2006

Renal insufficiency is an established risk factor in patients undergoing cardiovascular surgery. We sought to evaluate the relationship between renal function and outcomes after orthotopic heart transplantation (OHT).We conducted a retrospective review of 622 adults who underwent 628 consecutive OHTs between 1994 and 2001 at our institution. The recipients were divided into either normal (Group 1) or impaired (Group 2) pre-operative renal function. Impaired renal function was defined as creatinine clearance (CrCl) < 40 ml/min (Cockroft-Gault formula). Meanwhile, patients in Group 1 (normal) were defined by CrCl ≥ 40 ml/min. The primary end points of the study were early and late mortality. The secondary end point included post-operative renal failure defined by the requirement of dialysis or renal allograft in the early post-operative period. The Kaplan-Meier method was used to determine actuarial survival.Early mortality was 7% (38/531) in Group 1 and 17% (16/96) in Group 2 (p = 0.002). Similarly, the death rate per 100 patient-years was 4.8 and 8.1 for the groups, respectively (p = 0.03). Nine percent of patients in Group 1 required post-operative dialysis (49/531), whereas 32% of recipients in Group 2 required this intervention (31/96) (p < 0.001). Early mortality was 41% for patients requiring post-operative dialysis and 3% for those not requiring such intervention (p < 0.001). Early mortality after post-operative dialysis was 41% (20/49) in Group 1 and 42% (13/31) in Group 2 (p = 0.2).CrCl < 40 ml/min is a useful marker for increased post-operative renal failure and mortality. Recipients who require post-operative dialysis have greatly increased mortality regardless of pre-operative CrCl. Dialysis in patients after heart transplantation carries a prohibitive risk. Dialysis as a bridge to renal transplantation may reduce this high mortality rate.