Cyclosporine-associated end-stage nephropathy after cardiac transplantation

Incidence and progression

Daniel J. Goldstein, Nancy Zuech, Vinita Sehgal, Alan D. Weinberg, Ronald Drusin, David Cohen

Research output: Contribution to journalArticle

190 Citations (Scopus)

Abstract

Background. The salutary immunosuppressive effects of cyclosporine in extending cardiac allograft survival may be curtailed by its nephrotoxic effects. We reviewed our first 9 years of experience with cyclosporine after cardiac transplantation, to evaluate the incidence and progression of cyclosporine-associated end-stage renal failure necessitating chronic hemodialysis. Methods. Retrospective computer-based file review and personal interview when possible. Results. The population at risk was comprised of all adult cardiac recipients surviving at least 3 years (n=293). Of these, 19 (6.5%) developed end-stage renal failure requiring chronic hemodialysis. There were 17 men and 2 women (mean age of 45±11 years). The mean creatinine clearance for the study group decreased by 38% (P<0.001 vs. before transplant) by 6 months after transplantation and by 48% by 3 years postoperatively (P<0.001 vs. before transplant). The mean serum creatinine rose by 80% (P<0.001 vs. before transplant) by 6 months after transplantation and by 125% by 3 years postoperatively (P<0.001 vs. before transplant). Time elapsed from transplantation to hemodialysis ranged from 3.7 to 9.5 years (mean 6.4±2). Actuarial 1- year survival after onset of hemodialysis was 75%. Conclusions. Although cyclosporine remains the central immunosuppressive agent for cardiac allograft recipients, its use leads to a greater than one- third decrease in creatinine clearance by 6 months after transplantation and progression to end-stage renal failure, requiring hemodialysis in 6.5% of cardiac transplant recipients. Moreover, these patients are at increased risk of death compared with other cardiac allograft recipients. This data warrants the search of alternative or adjunctive agents that would allow decreased dosing or reduced nephrotoxicity of cyclosporine, while maintaining equivalent survival.

Original languageEnglish (US)
Pages (from-to)664-668
Number of pages5
JournalTransplantation
Volume63
Issue number5
DOIs
StatePublished - Mar 15 1997
Externally publishedYes

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Heart Transplantation
Cyclosporine
Renal Dialysis
Transplantation
Incidence
Chronic Kidney Failure
Allografts
Transplants
Creatinine
Immunosuppressive Agents
Survival
Interviews
Serum

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Cyclosporine-associated end-stage nephropathy after cardiac transplantation : Incidence and progression. / Goldstein, Daniel J.; Zuech, Nancy; Sehgal, Vinita; Weinberg, Alan D.; Drusin, Ronald; Cohen, David.

In: Transplantation, Vol. 63, No. 5, 15.03.1997, p. 664-668.

Research output: Contribution to journalArticle

Goldstein, Daniel J. ; Zuech, Nancy ; Sehgal, Vinita ; Weinberg, Alan D. ; Drusin, Ronald ; Cohen, David. / Cyclosporine-associated end-stage nephropathy after cardiac transplantation : Incidence and progression. In: Transplantation. 1997 ; Vol. 63, No. 5. pp. 664-668.
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abstract = "Background. The salutary immunosuppressive effects of cyclosporine in extending cardiac allograft survival may be curtailed by its nephrotoxic effects. We reviewed our first 9 years of experience with cyclosporine after cardiac transplantation, to evaluate the incidence and progression of cyclosporine-associated end-stage renal failure necessitating chronic hemodialysis. Methods. Retrospective computer-based file review and personal interview when possible. Results. The population at risk was comprised of all adult cardiac recipients surviving at least 3 years (n=293). Of these, 19 (6.5{\%}) developed end-stage renal failure requiring chronic hemodialysis. There were 17 men and 2 women (mean age of 45±11 years). The mean creatinine clearance for the study group decreased by 38{\%} (P<0.001 vs. before transplant) by 6 months after transplantation and by 48{\%} by 3 years postoperatively (P<0.001 vs. before transplant). The mean serum creatinine rose by 80{\%} (P<0.001 vs. before transplant) by 6 months after transplantation and by 125{\%} by 3 years postoperatively (P<0.001 vs. before transplant). Time elapsed from transplantation to hemodialysis ranged from 3.7 to 9.5 years (mean 6.4±2). Actuarial 1- year survival after onset of hemodialysis was 75{\%}. Conclusions. Although cyclosporine remains the central immunosuppressive agent for cardiac allograft recipients, its use leads to a greater than one- third decrease in creatinine clearance by 6 months after transplantation and progression to end-stage renal failure, requiring hemodialysis in 6.5{\%} of cardiac transplant recipients. Moreover, these patients are at increased risk of death compared with other cardiac allograft recipients. This data warrants the search of alternative or adjunctive agents that would allow decreased dosing or reduced nephrotoxicity of cyclosporine, while maintaining equivalent survival.",
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AU - Drusin, Ronald

AU - Cohen, David

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N2 - Background. The salutary immunosuppressive effects of cyclosporine in extending cardiac allograft survival may be curtailed by its nephrotoxic effects. We reviewed our first 9 years of experience with cyclosporine after cardiac transplantation, to evaluate the incidence and progression of cyclosporine-associated end-stage renal failure necessitating chronic hemodialysis. Methods. Retrospective computer-based file review and personal interview when possible. Results. The population at risk was comprised of all adult cardiac recipients surviving at least 3 years (n=293). Of these, 19 (6.5%) developed end-stage renal failure requiring chronic hemodialysis. There were 17 men and 2 women (mean age of 45±11 years). The mean creatinine clearance for the study group decreased by 38% (P<0.001 vs. before transplant) by 6 months after transplantation and by 48% by 3 years postoperatively (P<0.001 vs. before transplant). The mean serum creatinine rose by 80% (P<0.001 vs. before transplant) by 6 months after transplantation and by 125% by 3 years postoperatively (P<0.001 vs. before transplant). Time elapsed from transplantation to hemodialysis ranged from 3.7 to 9.5 years (mean 6.4±2). Actuarial 1- year survival after onset of hemodialysis was 75%. Conclusions. Although cyclosporine remains the central immunosuppressive agent for cardiac allograft recipients, its use leads to a greater than one- third decrease in creatinine clearance by 6 months after transplantation and progression to end-stage renal failure, requiring hemodialysis in 6.5% of cardiac transplant recipients. Moreover, these patients are at increased risk of death compared with other cardiac allograft recipients. This data warrants the search of alternative or adjunctive agents that would allow decreased dosing or reduced nephrotoxicity of cyclosporine, while maintaining equivalent survival.

AB - Background. The salutary immunosuppressive effects of cyclosporine in extending cardiac allograft survival may be curtailed by its nephrotoxic effects. We reviewed our first 9 years of experience with cyclosporine after cardiac transplantation, to evaluate the incidence and progression of cyclosporine-associated end-stage renal failure necessitating chronic hemodialysis. Methods. Retrospective computer-based file review and personal interview when possible. Results. The population at risk was comprised of all adult cardiac recipients surviving at least 3 years (n=293). Of these, 19 (6.5%) developed end-stage renal failure requiring chronic hemodialysis. There were 17 men and 2 women (mean age of 45±11 years). The mean creatinine clearance for the study group decreased by 38% (P<0.001 vs. before transplant) by 6 months after transplantation and by 48% by 3 years postoperatively (P<0.001 vs. before transplant). The mean serum creatinine rose by 80% (P<0.001 vs. before transplant) by 6 months after transplantation and by 125% by 3 years postoperatively (P<0.001 vs. before transplant). Time elapsed from transplantation to hemodialysis ranged from 3.7 to 9.5 years (mean 6.4±2). Actuarial 1- year survival after onset of hemodialysis was 75%. Conclusions. Although cyclosporine remains the central immunosuppressive agent for cardiac allograft recipients, its use leads to a greater than one- third decrease in creatinine clearance by 6 months after transplantation and progression to end-stage renal failure, requiring hemodialysis in 6.5% of cardiac transplant recipients. Moreover, these patients are at increased risk of death compared with other cardiac allograft recipients. This data warrants the search of alternative or adjunctive agents that would allow decreased dosing or reduced nephrotoxicity of cyclosporine, while maintaining equivalent survival.

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