原位心脏移植后肾功能的自然病程。

The natural history of renal function following orthotopic heart transplant.

作者信息

Al Aly Ziyad, Abbas Samer, Moore Eric, Diallo Ousmane, Hauptman Paul J, Bastani Bahar

机构信息

Division of Nephrology, Saint Louis University, Saint Louis, MO 63110, USA.

出版信息

Clin Transplant. 2005 Oct;19(5):683-9. doi: 10.1111/j.1399-0012.2005.00408.x.

DOI:10.1111/j.1399-0012.2005.00408.x

PMID:16146562

Abstract

BACKGROUND

The outcome of solid organ transplantation has dramatically improved after the introduction of the calcineurin inhibitor cyclosporine. With the increasing longevity of heart transplant recipients, the long-term effects of cyclosporine on renal function have become more evident. The natural history of kidney function following orthotopic heart transplant is not well defined and long-term follow up studies are scant.

METHODS

We conducted an observational study on patients who received a heart transplant at Saint Louis University Hospital between January 1, 1983 and December 31, 1988. Patients were followed up for 15 yr or until death whichever occurred first. In order to assess the effect of heart transplantation and cyclosporine exposure on long-term renal function we restricted the statistical analysis to patients who survived the first year post-transplantation.

RESULTS

A total of 68 patients received orthotopic heart transplants at Saint Louis University Hospital between 1983 and 1988. Forty-eight (71%) patients survived for more than 1 yr. All patients were treated with cyclosporine based triple immunosuppressive regimen, with gradual cyclosporine dose reduction over time. The mean duration of follow-up was 8 yr. The estimated GFR at 5 and 10 yr post-transplant were significantly lower than estimated GFR at baseline and 1 yr post-transplant. There was no significant difference between estimated GFR at 15 yr and estimated GFR at baseline or 1 yr post-transplant. The cumulative incidence of chronic renal failure (GFR < or = 29 mL/min/1.73 m2) at 5, 10 and 15 yr was 4.2, 10.4 and 12.5%, respectively (p < 0.05). The cumulative incidence of severe chronic renal failure (GFR < or = 15 mL/min/1.73 m2) at 5, 10 and 15 yr was 2.1, 8.3 and 8.3%, respectively. The mortality rate was 8, 37, and 52% at 5, 10, and 15 yr, respectively. The 10 and 15 yr survivors had an estimated GFR at 1 yr post-transplant that was significantly higher than the non-survivors. Age, pre-transplantation estimated GFR, pre-transplantation diabetes and pre-transplantation hypertension are risk factors associated with > or = 10 mL/min/1.73 m2 decrement in estimated GFR.

CONCLUSION

Heart transplant survivors beyond the first year post-transplant have a significant decrease in renal function and significant mortality observed over time. Age, pre-transplant GFR, pre-transplant diabetes and pre-transplant hypertension are important risk factors for decrement in renal function.

摘要

背景

自引入钙调神经磷酸酶抑制剂环孢素后，实体器官移植的疗效有了显著改善。随着心脏移植受者寿命的延长，环孢素对肾功能的长期影响变得更加明显。原位心脏移植后肾功能的自然病程尚不明确，长期随访研究也很少。

方法

我们对1983年1月1日至1988年12月31日在圣路易斯大学医院接受心脏移植的患者进行了一项观察性研究。对患者进行了15年的随访，或直至死亡，以先发生者为准。为了评估心脏移植和环孢素暴露对长期肾功能的影响，我们将统计分析限制在移植后第一年存活的患者。

结果

1983年至1988年期间，共有68例患者在圣路易斯大学医院接受了原位心脏移植。48例（71%）患者存活超过1年。所有患者均接受基于环孢素的三联免疫抑制方案治疗，随着时间的推移，环孢素剂量逐渐减少。平均随访时间为8年。移植后5年和10年的估计肾小球滤过率（GFR）显著低于基线和移植后1年的估计GFR。移植后15年的估计GFR与基线或移植后1年的估计GFR之间无显著差异。5年、10年和15年慢性肾衰竭（GFR≤29 mL/min/1.73 m2）的累积发生率分别为4.2%、10.4%和12.5%（p<0.05）。5年、10年和15年严重慢性肾衰竭（GFR≤15 mL/min/1.73 m2）的累积发生率分别为2.1%、8.3%和8.3%。5年、10年和15年的死亡率分别为8%、37%和52%。10年和15年的存活者移植后1年的估计GFR显著高于非存活者。年龄、移植前估计GFR、移植前糖尿病和移植前高血压是与估计GFR下降≥10 mL/min/1.73 m2相关的危险因素。