HDCN Abstract:  ASN Annual Meeting -- San Francisco  

Boyer O, Iserin F, Dechaux M, et al.

Long-Lasting Improvement of Renal Function in Pediatric Heart Transplant Recipients Treated with Low-Dose Calcineurin Inhibitors and Mycophenolate Mofetil.

ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:681A 2007

Chronic renal dysfunction is a major complication after heart transplantation (HTx). The pathophysiology is not yet fully understood but is thought to be in part due to calcineurin inhibitor (CNI) toxicity, and reducing CNI exposure has become one of the main strategies aimed at ameliorating renal outcome in HTx recipients.

We previously reported a significant improvement of renal function in 14 HTx children with biopsy-proven CNI nephrotoxicity and chronic renal failure, 1 year after the reduction of CNI dosage by 50% with a concomitant replacement of azathioprine by mycophenolate mofetil. We ought to determine whether this improvement was persistent after 3 years of follow-up, despite the histological lesions of chronic CNI nephrotoxicity. GFR evaluated by annual inulin clearance had improved from a mean of 46.5 9.6 ml/min/1.73m2 (range 34-60) at time of the switch to 77.6 16.0 ml/min/1.73m2 (range 54-102) (p=0.019) one year after (67% improvement), and remained stable at 76.4 18.2 ml/min/1.73m2 (range 50-102) (p= 0.76) 3 years after the switch.

Maximal urinary osmolality followed the same increase profile from 559 103 mOsm/Kg before the switch to 762 122 at one year and 736 154 after 3 years (p= 0.64). Meanwhile, the occurrence of serious adverse events such as infectious episodes, acute rejection and chronic allograft dysfunction as assessed by clinical examination, echocardiography and endomyocardial biopsies were not different from a control group of patients whose treatment was unchanged.

No malignancy was observed in either group. In conclusion, reduction of CNI dosage and replacement of azathioprine by mycophenolate mofetil lead to a safe and long-lasting improvement of renal function in children with heart transplants and CNI- induced nephropathy.

© Copyright 2007-2008, American Society of Nephrology. Reproduced with permission.
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