RENAL-INSUFFICIENCY AFTER HEART-TRANSPLANTATION - A CASE-CONTROL STUDY

Background, In Rotterdam 304 heart transplants have been performed sin ce 1984. End-stage renal failure, necessitating renal replacement ther apy, has developed in 24 patients (8%) after an interval of 25-121 mon ths (median 79 months). After starting renal replacement therapy one-y ear survival was only 60%. Overall survival after heart transplantatio n, however, was favourable: 5 and 10 year survival rates of 79% and 50 % respectively. Methods. A case-control study was performed to identif y possible risk factors in cases who went on to develop end-stage rena l failure compared to controls. Results, We found that renal failure w as not limited to elderly patients with ischaemic heart disease, but a lso occurred in young patients having dilated cardiomyopathy. A signif icant rise in the serum creatinine was found in cases compared to cont rols as early as 3 months after transplantation, Cyclosporin dose and trough levels were not different between cases and controls. Neither w ere there differences in the use of calcium-antagonists or other antih ypertensive drugs, allopurinol or diuretics. Rejection incidence was a lso similar between the two groups. Conclusions. Renal failure after h eart transplantation is a long term complication of cyclosporin use th at is not limited to elderly patients with ischaemic heart disease. Cy closporin dose and trough levels in the cases were nor different from patients maintaining stable good renal function, indicating that cyclo sporin nephrotoxicity is the result of an individually determined susc eptibility to cyclosporin. Suggestions for future strategies to preven t renal failure are given.