Time course of the decline in renal function in cyclosporine-treated heart transplant recipients.
The renal side-effects are a major limitation of the use of cyclosporine A (CsA) following heart transplantation. In an effort to define the time course of the decline in renal function and to identify a group of patients especially prone to the nephrotoxic effects of CsA, we studied 187 orthotopic heart transplant recipients who had a follow-up of at least 1 month. All patients received oral CsA in a starting dose of 8 mg/kg and low-dose steroids. Renal function decreased steadily after transplantation. Serum creatinine was > 150 mumol/l in 52% of the patients after 2 years. After 4 years serum creatinine was > 250 mumol/l in 13% of the patients. No relation could be found between the decline in renal function (as defined by the slope of serum creatinine-1 versus time) and age, sex, creatinine levels before transplantation, blood pressure, CsA blood levels, the number of rejections or the use of calcium channel blocking drugs. We conclude that, despite reduction of CsA dosage, progressive renal insufficiency can be observed in an increasing percentage of heart transplant recipients. We were not able to identify patients with a poor renal prognosis in an early phase after transplantation.
Zietse
R
R
Department of Internal Medicine I, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Balk
A H
AH
vd Dorpel
M A
MA
Meeter
K
K
Bos
E
E
Weimar
W
W
D000328:Adult; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D016027:Heart Transplantation; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D013997:Time Factors
D016572:Cyclosporine; D003404:Creatinine