Renal-sparing strategies in cardiac transplantation

Current Opinion in Organ Transplantation

Volumn 14, Issue 5, 2009, Pages 566-570

  Gustafsson, Finn ^a   Ross, Heather J ^b  

^a UNIVERSITY OF COPENHAGEN   (Denmark)

^b TORONTO GENERAL HOSPITAL   (Canada)

Author keywords

Heart; Mycophenolate; Proliferation signal inhibitors; Renal; Transplantation

Indexed keywords

AZATHIOPRINE; CALCINEURIN INHIBITOR; EVEROLIMUS; MYCOPHENOLIC ACID; RAPAMYCIN;

CONTROLLED STUDY; DRUG EFFICACY; DRUG SAFETY; DRUG WITHDRAWAL; GRAFT RECIPIENT; GRAFT REJECTION; HEART TRANSPLANTATION; HUMAN; KIDNEY DYSFUNCTION; KIDNEY FUNCTION; PROTEINURIA; REVIEW; RISK ASSESSMENT;

GLOMERULAR FILTRATION RATE; GRAFT REJECTION; HEART FAILURE; HEART TRANSPLANTATION; HUMANS; IMMUNOSUPPRESSIVE AGENTS; KIDNEY; PROGNOSIS; RENAL INSUFFICIENCY; RISK FACTORS;

EID: 73349134261     PISSN: 10872418     EISSN: 15317013     Source Type: Journal    
DOI: 10.1097/MOT.0b013e32832e6f7b     Document Type: Review

References (46)

1. Taylor DO, Edwards LB, Aurora P, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult heart transplant report-2008. J Heart Lung Transplant 2008; 27:943-956.
2. Odim J, Wheat J, Laks H, et al. Peri-operative renal function and outcome after orthotopic heart transplantation. J Heart Lung Transplant 2006; 25:162-166.
3. Alam A, Badovinac K, Ivis F, et al. The outcome of heart transplant recipients following the development of end-stage renal disease: analysis of the Canadian Organ Replacement Register (CORR). Am J Transplant 2007; 7:461-465.
4. Cattaneo D, Perico N, Gaspari F, et al. Nephrotoxic aspects of cyclosporine. Transplant Proc 2004; 36:234S-239S.
5. Kobashigawa JA, Miller LW, Russell SD, et al. Tacrolimus with mycophenolate mofetil (MMF) or sirolimus vs. cyclosporine with MMF in cardiac transplant patients: 1-year report. Am J Transplant 2006; 6:1377-1386.
6. Rosenberg PB, Vriesendorp AE, Drazner MH, et al. Induction therapy with basiliximab allows delayed initiation of cyclosporine and preserves renal function after cardiac transplantation. J Heart Lung Transplant 2005; 24:1327-1331.
7. Cantarovich M, Giannetti N, Barkun J, et al. Antithymocyte globulin induction allows a prolonged delay in the initiation of cyclosporine in heart transplant patients with postoperative renal dysfunction. Transplantation 2004; 78:779-781.
8. Moller CH, Gustafsson F, Gluud C, et al. Interleukin-2 receptor antagonists as induction therapy after heart transplantation: systematic review with meta-analysis of randomized trials. J Heart Lung Transplant 2008; 27:835-842.
9. Delgado DH, Miriuka SG, Cusimano RJ, et al. Use of basiliximab and cyclosporine in heart transplant patients with preoperative renal dysfunction. J Heart Lung Transplant 2005; 24:166-169.
10. Hamour IM, Lyster HS, Burke MM, et al. Mycophenolate mofetil may allow cyclosporine and steroid sparing in de novo heart transplant patients. Transplantation 2007; 83:570-576.
11. Manito N, Kaplinsky EJ, Roca J, et al. Heart transplant recipient clinical profile improvement following mycophenolate mofetil late incorporation into the treatment schedule. Clin Transplant 2005; 19:304-308.
12. Zuckermann A, Ploner M, Keziban U, et al. Benefit of mycophenolate- mofetil (MMF) in patients with cyclosporine (CYA) induced nephropathy after cardiac transplantation. J Heart Lung Transplant 2001; 20:163.
13. Angermann CE, Stork S, Costard-Jackle A, et al. Reduction of cyclosporine after introduction of mycophenolate mofetil improves chronic renal dysfunction in heart transplant recipients: the IMPROVED multicentre study. Eur Heart J 2004; 25:1626-1634.
14. Keogh A, Richardson M, Ruygrok P, et al. Sirolimus in de novo heart transplant recipients reduces acute rejection and prevents coronary artery disease at 2 years: a randomized clinical trial. Circulation 2004; 110:2694-2700.
15. Eisen HJ, Tuzcu EM, Dorent R, et al. Everolimus for the prevention of allograft rejection and vasculopathy in cardiac-transplant recipients. N Engl J Med 2003; 349:847-858.
16. Meiser B, Kaczmarek I, Mueller M, et al. Low-dose tacrolimus/sirolimus and steroid withdrawal in heart recipients is highly efficacious. J Heart Lung Transplant 2007; 26:598-603.
17. Lehmkuhl HB, Mai D, Dandel M, et al. Observational study with everolimus (Certican) in combination with low-dose cyclosporine in de novo heart transplant recipients. J Heart Lung Transplant 2007; 26:700-704.
18. Ross H, Pflugfelder P, Haddad H, et al. Cyclosporine reduction in the presence of everolimus: 3-month data from a Canadian pilot study of maintenance cardiac allograft recipients. J Heart Lung Transplant 2008; 27:197-202.
19. Schweiger M, Wasler A, Prenner G, et al. Everolimus and reduced cyclosporine trough levels in maintenance heart transplant recipients. Transpl Immunol 2006; 16:46-51.
20. Trosch F, Rothenburger M, Schneider M, et al. First experience with rapamycin-based immunosuppression to improve kidney function after heart transplantation. Thorac Cardiovasc Surg 2004; 52:163-168.
21. Hunt J, Bedanova H, Starling RC, et al. Premature termination of a prospective, open-label, randomized, multicentre trial of Srl to replace CNIs in a standard care regimen of CNI, MMF and corticosteroids early after heart transplantation [abstract]. J Heart Lung Transplant 2007; 26:S203.
22. Hunt J, Lerman M, Magee MJ, et al. Improvement of renal dysfunction by conversion from calcineurin inhibitors to sirolimus after heart transplantation. J Heart Lung Transplant 2005; 24:1863-1867.
23. Aranda-Dios A, Lage E, Sobrino JM, et al. Sirolimus experience in heart transplantation. Transplant Proc 2006; 38:2547-2549.
24. Bestetti R, Theodoropoulos TA, Burdmann EA, et al. Switch from calcineurin inhibitors to sirolimus-induced renal recovery in heart transplant recipients in the midterm follow-up. Transplantation 2006; 81:692-696.
25. Rothenburger M, Teerling E, Bruch C, et al. Calcineurin inhibitor-free immunosuppression using everolimus (Certican) in maintenance heart transplant recipients: 6 months' follow-up. J Heart Lung Transplant 2007; 26:250-257.
26. Raichlin E, Khalpey Z, Kremers W, et al. Replacement of calcineurin-inhibitors with sirolimus as primary immunosuppression in stable cardiac transplant recipients. Transplantation 2007; 84:467-474.
27. Snell GI, Levvey BJ, Chin W, et al. Sirolimus allows renal recovery in lung and heart transplant recipients with chronic renal impairment. J Heart Lung Transplant 2002; 21:540-546.
28. Groetzner J, Meiser B, Landwehr P, et al.Mycophenolate mofetil and sirolimus as calcineurin inhibitor-free immunosuppression for late cardiac-transplant recipients with chronic renal failure. Transplantation 2004; 77:568-574. (Pubitemid 38282814)
29. Kushwaha SS, Khalpey Z, Frantz RP, et al. Sirolimus in cardiac transplantation: use as a primary immunosuppressant in calcineurin inhibitor-induced nephrotoxicity. J Heart Lung Transplant 2005; 24:2129-2136.
30. Gleissner CA, Doesch A, Ehlermann P, et al. Cyclosporine withdrawal improves renal function in heart transplant patients on reduced-dose cyclosporine therapy. Am J Transplant 2006; 6:2750-2758.
31. Potter BJ, Giannetti N, Edwardes MD, et al. Calcineurin inhibitor substitution with sirolimus vs. reduced-dose calcineurin inhibitor plus sirolimus is associated with improved renal dysfunction in heart transplant patients. Clin Transplant 2007; 21:305-308.
32. Groetzner J, Kaczmarek I, Schulz U, et al. Mycophenolate and sirolimus as calcineurin inhibitor-free immunosuppression improves renal function better than calcineurin inhibitor-reduction in late cardiac transplant recipients with chronic renal failure. Transplantation 2009; 87:726-733. A fairly large prospective, randomized, multicentre trial showing that conversion to a CNI-free regimen improves renal function more than conversion a CNI-reduced strategy.
33. Gustafsson F, Ross HJ, Delgado MS, et al. Sirolimus-based immunosuppression after cardiac transplantation: predictors of recovery from calcineurin inhibitor-induced renal dysfunction. J Heart Lung Transplant 2007; 26:998-1003.
34. Aliabadi AZ, Pohanka E, Seebacher G, et al. Development of proteinuria after switch to sirolimus-based immunosuppression in long-term cardiac transplant patients. Am J Transplant 2008; 8:854-861. The first study in cardiac transplantation to document that proteinuria is associated with lack of improvement in renal function after switching to a PSI-based immunosuppressive regimen.
35. Meiser B, Reichart B, Adamidis I, et al. First experience with de novo calcineurin-inhibitor-free immunosuppression following cardiac transplantation. Am J Transplant 2005; 5:827-831.
36. Fernandez-Valls M, Gonzalez-Vilchez F, de Prada JA, et al. Sirolimus as an alternative to anticalcineurin therapy in heart transplantation: experience of a single center. Transplant Proc 2005; 37:4021-4023.
37. Leet AS, Bergin PJ, Richardson M, et al. Outcomes following de novo CNI-free immunosuppression after heart transplantation: a single-center experience. Am J Transplant 2009; 9:140-148. The above is one of the largest published series of studies of de-novo CNI-free cardiac transplant recipients in whom an increased incidence of rejection was found.
38. Solari SG, Goldberg LR, DeNofrio D, et al. Cyclosporine monitoring with 2-h postdose levels in heart transplant recipients. Ther Drug Monit 2005; 27:417-421.
39. Cantarovich M, Besner JG, Barkun JS, et al. Two-hour cyclosporine level determination is the appropriate tool to monitor Neoral therapy. Clin Transplant 1998; 12:243-249.
40. Delgado DH, Rao V, Hamel J, et al. Monitoring of cyclosporine 2-h postdose levels in heart transplantation: improvement in clinical outcomes. J Heart Lung Transplant 2005; 24:1343-1346.
41. Cantarovich M, Ross H, Arizon JM, et al. Benefit of Neoral C2 monitoring in de novo cardiac transplant recipients receiving basiliximab induction. Transplantation 2008; 85:992-999. This study documented that C2 cyclosporine monitoring aiming for rather low values in de-novo cardiac transplantation is feasible and safe.
42. Kittleson MM, Skye A, Felker GM, et al. De novo C2 monitoring immediately after cardiac transplantation is not associated with improved renal function (abstract). J Heart Lung Transplant 2006; 25:S127.
43. Mathias HC, Ozalp F, Will MB, et al. A randomized, controlled trial of C0- Vs C2-guided therapeutic drug monitoring of cyclosporine in stable heart transplant patients. J Heart Lung Transplant 2005; 24:2137-2143.
44. Cantarovich M, Elstein E, de Varennes B, et al. Clinical benefit of neoral dose monitoring with cyclosporine 2-hr postdose levels compared with trough levels in stable heart transplant patients. Transplantation 1999; 68:1839-1842.
45. Hausberg M, Barenbrock M, Hohage H, et al. ACE inhibitor versus betablocker for the treatment of hypertension in renal allograft recipients. Hypertension 1999; 33:862-868.
46. Midtvedt K, Hartmann A, Foss A, et al. Sustained improvement of renal graft function for two years in hypertensive renal transplant recipients treated with nifedipine as compared to lisinopril. Transplantation 2001; 72:1787-1792.