PROGRESSIVE RENAL-INSUFFICIENCY FOLLOWING CARDIAC TRANSPLANTATION - CYCLOSPORINE, LIPIDS, AND HYPERTENSION

The increasing success of cardiac transplantation has been attributed to the availability of potent immunosuppressive agents, including cycl osporine. With improved graft and patient survival, the incidence of c hronic renal insufficiency has increased. We reviewed the medical reco rds of patients who had undergone orthotopic cardiac transplantation a nd had been followed for at least 3 years posttransplantation to deter mine the risk factors at initial evaluation and in the early posttrans plantation period for subsequent renal insufficiency. We followed 80 a dult patients over a mean period of 4.7 years: 39 patients had a serum creatinine greater than or equal to 2.4 mg/dL at last follow-up (rena l insufficiency or RI group); 41 patients had a serum creatinine less than or equal to 1.7 mg/dL at last follow-up (controls). RI patients t ended to be older and had a lower mean glomerular filtration rate (GFR ) at initial evaluation. There were no differences in race, gender, or previous history of hypertension between the two groups. Although bot h groups experienced an improvement in GFR at transplantation and a su bsequent decline in GFR by 6 months posttransplantation, the RI group achieved a lower peak GFR at transplantation and a far lower mean GFR at the 6-month analysis. Only the RI group showed a continued decline in GFR. The RI group had more severe hypertension and required a signi ficantly greater number of antihypertensive medications. The RI group had a higher mean total cholesterol at 6 months, but this difference w as not sustained. They also had higher triglyceride levels and lower h igh-density lipoprotein (HDL) levels; there was no difference in low-d ensity lipoprotein (LDL) levels. There was no difference in initial, m aximum, or mean doses of cyclosporine at 6 months, or of cyclosporine levels at any time. We conclude that older patients with greater prior renal insufficiency and those whose 6-month GFR is more markedly depr essed are at a higher risk for progressive renal failure. This group s hould be targeted for newer interventions to avoid renal failure. (C) 1995 by the National Kidney Foundation, Inc.