title: The incidence of end-stage renal failure in 17 years of heart transplantation: a single center experience.
abstract: BACKGROUND
  Predictions of the incidence of renal failure within a heart transplant population are based on the early experiences of cyclosporine (CsA)-based immunosuppression. We report a single-center experience of end-stage renal failure (ESRF) during a 17-year period encompassing current lower dose CsA regimens.
  
  
  METHODS
  Prospectively collected data were analyzed on all patients who underwent first heart transplants between April 1982 and February 1999 (n = 697). We further categorized patients by the date of transplantation into a higher and lower dosage maintenance CsA group.
  
  
  RESULTS
  End-stage renal failure developed in 44 patients. The median time to dialysis was 87 months after transplantation and was independent of the initial CsA regimens used (p = 0.798). In the ESRF group, 14 underwent hemodialysis, 28 underwent peritoneal dialysis, and 9 underwent renal transplantation. One- and 5-year survival rates after dialysis were 82% and 62% respectively. The incidence of ESRF at our institution was 5.8%. It increased with post-operative survival and was independent of the initial CsA regimen used. We found no difference in pre-transplant age, sex, diagnosis, immediate post-operative creatinine, or the development of diabetes between the ESRF group and controls. The ESRF group received higher dosages of CsA within the first post-transplant year, although this did not reach significance (CsA dosage, 5.9 microg/kg/day vs 5.1 microg/kg/day, respectively p = 0.075).
  
  
  CONCLUSIONS
  Lower dosage CsA regimes have not altered the incidence of ESRF at our institution, suggesting an individual predisposition to nephropathy. Therefore, reduction in the future incidence of ESRF may rely on extremely low-dose or calcineurin-free immunosuppression regimes.
authors.affiliation: Transplant Unit, Papworth Hospital, Everard, Cambridge, United Kingdom.
authors.forename: Duwarakan K
authors.initials: DK
authors.lastname: Satchithananda
authors.forename: Jayan
authors.initials: J
authors.lastname: Parameshwar
authors.forename: Linda
authors.initials: L
authors.lastname: Sharples
authors.forename: Gordon J
authors.initials: GJ
authors.lastname: Taylor
authors.forename: Keith
authors.initials: K
authors.lastname: McNeil
authors.forename: John
authors.initials: J
authors.lastname: Wallwork
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Large
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine