title: Kidney transplantation as a therapeutic option for end-stage renal disease developing after heart transplantation.
abstract: BACKGROUND
  Progressive renal failure is a frequent complication after heart transplantation (HTx). It may result in end-stage renal disease (ESRD), prompting consideration of kidney Tx after HTx (KAH).
  
  
  METHODS
  We performed a retrospective single-center study of 268 HTx recipients to evaluate outcomes after KAH compared with HTx recipients with and without ESRD.
  
  
  RESULTS
  During a median follow-up of 76 months, ESRD developed in 51 patients (19), and 39 of them (76%) underwent KAH. The mean time from HTx to ESRD was 83 months. The incidence of switching to a calcineurin inhibitor (CNI)-free regimen based on sirolimus was significantly lower among recipients with ESRD (6% vs 57%, p = 0.0001), and prolonged exposure to CNI significantly increased the risk for ESRD (hazard ratio, 1.09; 95% confidence interval, 1.03-1.15; p < 0.005). Death-censored renal graft survival after KAH was 95%, 95%, and 83% at 1, 5, and 10 years, respectively. Median long-term survival of KAH patients was comparable to HTx recipients without ESRD (17.5 vs 17.1 years, p = 0.27) and significantly better compared with HTx recipients with ESRD (17.5 vs 7.3 years, p < 0.001).
  
  
  CONCLUSIONS
  Prolonged exposure to CNI immunosuppression medications significantly increases the risk for ESRD among HTx recipients. KAH is a good therapeutic option for HTx recipients with ESRD, with survival benefit comparable to HTx without ESRD.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota.
authors.forename: Avishay
authors.initials: A
authors.lastname: Grupper
authors.affiliation: William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota; Divisions of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ayelet
authors.initials: A
authors.lastname: Grupper
authors.affiliation: Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota.
authors.forename: Naveen L
authors.initials: NL
authors.lastname: Pereira
authors.affiliation: Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Hathcock
authors.affiliation: Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kremers
authors.affiliation: William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota; Divisions of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
authors.forename: Fernando G
authors.initials: FG
authors.lastname: Cosio
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brooks S
authors.initials: BS
authors.lastname: Edwards
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota. Electronic address: kushwaha.sudhir@mayo.edu.
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002423:Cause of Death; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006333:Heart Failure / Q000175:diagnosis / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014481:United States
keywords: calcineurin inhibitor; heart transplantation; kidney transplantation; renal failure