Management of Calcineurin Inhibitors-Related Chronic Kidney Disease in Cardiac Transplantation
|Associate Professor of Medicine1, Professor of Cardiology2, F. Shakar 1 2 *|
|1Associate Professor of Medicine, Division of Cardiology, University of Colorado Denver, Aurora, Colorado Andreas Brieke|
|2Professor of Cardiology, Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska Brian D. Lowes|
|Corresponding Author :||Simon F. Shakar
Division of Cardiology, Academic Office Building 1
12631 East 17th Avenue, Box B130, Aurora, CO 80045
Tel: (303) 724 9089
Fax: (303) 724 2094
E-mail: [email protected]
|Received June 06, 2013; Accepted July 29, 2013; Published August 06, 2013|
|Citation: Brieke A, Lowes BD, Shakar SF (2013) Management of Calcineurin Inhibitors-Related Chronic Kidney Disease in Cardiac Transplantation. J Cardiovasc Dis Diagn 1:117. doi: 10.4172/2329-9517.1000117|
|Copyright: © 2013 Brieke A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Background: The use of calcineurin inhibitors revolutionized transplantation by prolonging patients’ survival.
However, their utility is limited by the development of significant chronic kidney disease.
Methods: We reviewed the English literature looking for recent publications regarding the management
of chronic kidney disease in cardiac transplant patients. We chose relevant papers based on design, number of patients and clinical utility.
Results: Most publications on the subject involve small populations with few prospective, randomized studies. Early use of tacrolimus appears to be associated with better kidney function after one year compared to cyclosporine. Once chronic kidney disease is established, successful strategies include reduction or elimination of calcineurin inhibitors while relying on mycophenolate mofetil, proliferation signal inhibitors or anti-CD 25 antibodies to prevent rejection. There is no follow up longer than two years with these approaches. Kidney transplantation might offer improved long-term survival compared to dialysis in end-stage disease.
Conclusions: Prospective studies with long-term follow-up are needed to decide about the timing and to confirm the utility of replacing calcineurin inhibitors with other agents in cardiac transplant patients with chronic kidney disease.