Patient survival with renal replacement therapy in heart transplantation patients.

Long-term survivors of cardiac transplantation are at risk for nephrotoxicity caused by many years of immunosuppressive therapy with cyclosporine or tacrolimus. We report on 12 patients who received heart transplants at the University of Pittsburgh, with subsequent development of end-stage renal disease (ESRD), who received renal replacement therapy at the university affiliated dialysis program. Patients were grouped by initial dialysis modality as intent to treat. Four patients were on chronic hemodialysis (HD) and eight on peritoneal dialysis (PD). Six patients died, two on HD and four on PD. There were 451 deaths per 1000 patient years for patients on PD compared with 273 deaths per 1000 patients years for patients on HD (p < 0.0001), both significantly higher than the United States Renal Data System rate of 178 per 1000 patient years for patients with ESRD who were of similar age and race, p < 0.0001. The survival rate for patients on PD seemed to be worse, but that may be because unstable patients with failing heart transplants were directed toward PD. Efforts should be made to minimize nephrotoxicity after cardiac transplantation.