Renal Function After Pediatric Cardiac Transplantation: The Effect of Early Cyclosporin Dosage

• Published in: Pediatrics (Evanston) 2001-06, Vol.107 (6), p.1346-1350
• Main Authors: Hornung, Tim S, de Goede, Christian G.E.L, O'Brien, Chris, Moghal, Nadeem E, Dark, John H, O'Sullivan, John J
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Causes of; Child; Child, Preschool; Complications and side effects; Cyclosporine; Cyclosporine - administration & dosage; Cyclosporine - adverse effects; Cyclosporine - pharmacology; Cyclosporins; Dose-Response Relationship, Drug; Drug therapy; Drug toxicity and drugs side effects treatment; Female; Graft Rejection - prevention & control; Heart; Heart Transplantation; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - pharmacology; Kidney - drug effects; Kidney - physiology; Kidney diseases; Kidney Diseases - chemically induced; Kidney Diseases - diagnosis; Kidney Function Tests - statistics & numerical data; Kidneys; Male; Medical sciences; Pediatrics; Pharmacology. Drug treatments; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Toxicity: urogenital system; Transplantation; Transplants & implants
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.107.6.1346

There is little data on renal function in pediatric heart transplant recipients. Early rejection is a major concern and most units run high cyclosporin A (CyA) levels during the 2 to 3 months after transplantation. We sought to document long-term renal function after transplantation and to assess influence of early CyA levels. We reviewed all of our pediatric transplants between June 1985 and August 1998 who survived longer than 6 months (n = 54). Glomerular filtration rate (GFR) was estimated at 1, 2, 4, and 8 years posttransplantation using the Schwartz formula: GFR (mL/min/1.73m(2)) = [Ht(cm)/creatinine(micromol/L)] x X We also analyzed whether change in renal function correlated with trough CyA levels. Median age at transplant was 4 years and median follow-up was 5 years. Survival rates were 87% at 1 year and 80% at 5 years. Mean GFR pretransplant was 79 +/- 19 mL/min/1.73 m(2), reflecting prerenal impairment. One year later, mean GFR was 72 mL/min/1.73 m(2); after 2 years it was 65 mL/min/1.73 m(2), after 4 years (n = 35) it was 60 mL/min/1.73 m(2), and after 8 years (n = 14) it was 57 mL/min/1.73 m(2). CyA levels during the first 2 months correlated with the change in GFR during the first year (r(2) = 0.21). This study demonstrates for the first time that decline in renal function after heart transplantation correlates with early CyA exposure; this dysfunction persists even when CyA doses are subsequently reduced.