Abstract 19328: Clinical Predictors of Renal Failure in Heart Transplant Patients Following Initiation of Calcineurin Inhibitor Free Regimen
Purpose: Calcineurin inhibitor (CNI) therapy has been the cornerstone of standard triple-drug immunosuppressive therapy that has significantly improved outcomes after heart transplantation (HTx). However, CNI-induced nephrotoxicity remains a significant cause of morbidity and mortality. Renal-sparing protocols (RSP) using CNI-free regimens have improved renal function in some patients (pts). The clinical variables associated with development of renal failure despite RSP initiation are unknown. We therefore evaluated HTx pts on RSP for possible risk factors associated with renal failure.
Methods: Of 1,424 HTx pts between 1/1994 to 1/2011, 61 were identified who underwent RSP. Creatinine values were obtained at time of RSP initiation and ≥3 months post-RSP. The CKD-EPI Cr Equation (2009) was used to estimate GFR. We assessed pts for type of CNI, prednisone use, ACE-inhibitor/ARB use, calcium-channel blocker use, sex, race, hypertension, diabetes mellitus, obesity, and hypercholesterolemia. A logistic regression model was used to determine if there was an association between the clinical variables measured and stage IV renal failure (estimated GFR <30 mL/kg/m2).
Results: 40 patients (66%) developed renal failure at an average of 14.4 ± 12.8 months after initiating RSP. Pts with an estimated GFR <30 mL/kg/ m2 at time of RSP initiation had a 5.4-fold (1.69-17.26, p=0.004) higher risk of developing renal failure. By multivariate logistic regression, this relationship remained significant after controlling for potential confounders in the relationship between RSP and renal failure, with a 8.9-fold (1.64-48.4; p=0.01) risk of renal failure in pts with an estimated GFR <30 mL/kg/ m2 at time of RSP initiation. The other clinical variables tested did not significantly affect outcome (Table).
Conclusions: RSP does not appear to be effective in pts with advanced renal disease. RSP should be considered in pts with CNI nephrotoxicity at an earlier stage of the disease.
Author Disclosures: O. Elboudwarej: None. J. Patel: Research Grant; Modest; Alexion Pharmaceuticals. M. Kittleson: None. F. Liou: None. J. Kobashigawa: Research Grant; Modest; Xdx, Inc., Novartis Pharmaceuticals.
- © 2014 by American Heart Association, Inc.