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Long-term renal function in heart transplant children on cyclosporine treatment

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Abstract

Renal function deterioration is a reason of concern in heart transplantation. Our aim was to evaluate long-term renal function in heart transplant children on cyclosporine (CsA) treatment and to investigate the effect of several variables possibly involved in renal function deterioration. Creatinine clearances were retrospectively reviewed in 50 children (median follow 99.7 months after heart transplant). Gender, age, and body weight at transplant, rejection episodes, CsA cumulative dose, and trough levels were analyzed. After an initial increase of the glomerular filtration rate (GFR), renal function worsened in most patients; 28% of the children developed renal insufficiency (defined as GFR <80 ml/min per 1.73 m2), which was already evident in the first 3 years. Neither CsA dose, trough levels, nor other patient characteristics were found to be associated with renal function deterioration. In this study renal failure occurred in one-third of the patients. The lack of association of CsA with renal insufficiency may be explained by several reasons, including the limitations of the retrospective design of the study. However, it is possible that the nephrotoxic effect of CsA is more likely to occur in a set of predisposed patients. These must be soon identified to evaluate early a calcineurin inhibitor-sparing strategy.

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Acknowledgements

Dr. Rizzoni sadly passed away after the submission of this manuscript. This is one of the last contributions he has made to the field of pediatric nephrology throughout his brilliant carrier. His teaching and dedication to the care of children with renal diseases will always be missed.

We are grateful to Dr. Marina Cuttini for her advice and useful comments on the manuscripts.

The study was partially financed by a grant from the Italian Ministry of Health and did not receive any sponsorship or support from any company.

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Authors and Affiliations

  1. Division of Nephrology and Dialysis, Bambino Gesù Children’s Hospital and Research Institute, Piazza S. Onofrio 4, 00165, Rome, Italy

    Luca Dello Strologo, Antonia Legato, Claudia Pontesilli & Gianfranco Rizzoni

  2. Cardiac Transplant, Bambino Gesù Children’s Hospital and Research Institute, Rome, Italy

    Francesco Parisi

  3. Clinical Biochemistry, Bambino Gesù Children’s Hospital and Research Institute, Rome, Italy

    Anna Pastore

  4. Epidemiology Unit, Bambino Gesù Children’s Hospital and Research Institute, Rome, Italy

    Lucilla Ravà & Alberto E. Tozzi

Authors
  1. Luca Dello Strologo
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  2. Francesco Parisi
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  3. Antonia Legato
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  4. Claudia Pontesilli
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  5. Anna Pastore
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  6. Lucilla Ravà
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  7. Alberto E. Tozzi
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  8. Gianfranco Rizzoni
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Correspondence to Luca Dello Strologo.

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Strologo, L.D., Parisi, F., Legato, A. et al. Long-term renal function in heart transplant children on cyclosporine treatment. Pediatr Nephrol 21, 561–565 (2006). https://doi.org/10.1007/s00467-006-0037-2

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  • DOI: https://doi.org/10.1007/s00467-006-0037-2

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