Background. Heart transplantation (HT) remains the ultimate final therapy for patients with end-stage heart failure. To prevent rejection of the allograft, life-long immunosuppressive therapy is required. As survival after HT has improved over the past decades, long-term complications, such as chronic kidney disease (CKD) and osteoporosis, are of increasing importance for morbidity and mortality. Both CKD and osteoporosis may develop as adverse effects of the immunosuppressive therapy, as well as being consequences of various factors that are associated with heart failure prior to HT. Early detection and, possibly, prevention of CKD and osteoporosis may further improve post-HT survival.
Aims. Paper I aimed to study the incidence, predictors, and survival of CKD after HT as well as to evaluate two glomerular filtration rate (GFR) estimation equations in HT patients. Paper II-IV aimed to investigate the incidence of osteoporosis, bone mineral density (BMD) evolution, predictors of impaired BMD, and survival after HT in adults (paper II-III) and pediatric patients (IV). Finally, paper V aimed to identify plasma biomarkers that may predict changes in BMD and increase the understanding of impaired BMD after HT.
Methods. Paper I-IV were conducted as retrospective cohort studies including patients who underwent HT at any age (paper I), age ≥20 years (paper II-III), and age <20 years (paper IV) since 1988 at Skåne University Hospital in Lund. Follow-up continued until 2012 (paper I), 2016 (paper II-III), and 2019 (paper IV). Data was collected from clinical record from the transplant assessment (TA) before HT and from the annual check-ups up to 10 years after HT.
Results. CKD was frequent both before and after HT and had an impact on survival (paper I). The steepest decrease in BMD occurred during the first year after HT and pre-transplant BMD appeared to influence the development of osteoporosis up to 10 years after HT (paper II). Surprisingly, severe CKD before HT appeared favourable in terms of BMD after HT compared with patients without severe CKD, and was not associated with osteoporosis (paper III). Impaired lumbar BMD was common already before HT in pediatric patients, however, BMD recovered at the fourth year after HT (paper IV). BMD at 10 years after HT was independent of age at HT (pediatric versus adult). Elevated plasma levels of fibroblast growth factor-23 before HT predicted increased in lumbar BMD after HT (paper V).
Significance. Taken together, the present thesis provide an overview of clinical complications after HT with emphasis on CKD and osteoporosis covering information on the incidence, predictors, and survival.
- Department of Clinical Sciences, Lund
- Rådegran, Göran, Supervisor
- Nilsson, Johan, Assistant supervisor
|Award date||2021 Dec 10|
|Place of Publication||Lund|
|Publication status||Published - 2021|
Place: Segerfalksalen, BMC A10, Sölvegatan 17 i Lund. Join by Zoom: https://lu-se.zoom.us/j/64306007983
Name: Eisen, Howard J.
Title: Professor, MD
Affiliation: The Heart and Vascular Institute, Pennsylvania State University/Milton S. Hershey Medical Center, Pennsylvania, USA
- Cardiac and Cardiovascular Systems
- Endocrinology and Diabetes
- Heart Transplantation
- chronic kidney disase
- immunosuppressive agents