Renal insufficiency after heart transplantation: a case-control study

Background: In Rotterdam 304 heart transplants havebeen performed since 1984. End-stage renal failure, necessitating renalreplacement therapy, has developed in 24 patients (8%) after an interval of25-121 months (median 79 months). After starting renal replacement therapyone-year survival was only 60%. Overall survival after hearttransplantation, however, was favourable: 5 and 10 year survival rates of79% and 50% respectively. Methods: A case-controlstudy was performed to identify possible risk factors in cases who went onto develop end-stage renal failure compared to controls.Results: We found that renal failure was not limitedto elderly patients with ischaemic heart disease, but also occurred inyoung patients having dilated cardiomyopathy. A significant rise in theserum creatinine was found in cases compared to controls as early as 3months after transplantation. Cyclosporin dose and trough levels were notdifferent between cases and controls. Neither were there differences in theuse of calcium-antagonists or other antihypertensive drugs, allopurinol ordiuretics. Rejection incidence was also similar between the two groups.Conclusions: Renal failure after heart transplantationis a long term complication of cyclosporin use that is not limited toelderly patients with ischaemic heart disease. Cyclosporin dose and troughlevels in the cases were not different from patients maintaining stablegood renal function, indicating that cyclosporin nephrotoxicity is theresult of an individually determined susceptibility to cyclosporin.Suggestions for future strategies to prevent renal failure are given.