Purpose: Calcineurin inhibitors (CNI) such as cyclosporine and tacrolimus are known to cause chronic renal failure. As a result, programs have developed renal-sparing protocols (RSP) where CNI have been replaced by a second anti-proliferative agent. The long-term success of RSP after heart transplantation is not well established. We sought to assess this question with a review of our patients 5-years after RSP initiation.

Methods: Between 1994 and 2012 we identified 71 heart transplant patients who were placed on the renal-sparing protocol. RSP was successfully achieved in 66.2% (47/71) of patients. These 47 patients were compared 2:1 to a control group matched for age, sex, and time from transplant to assess the efficacy of the RSP. We analyzed subsequent 5-year change in creatinine and GFR, and freedom from any-treated rejection.

Results: The average time to RSP initiation was 7.0 years. As expected, at RSP initiation, there was a higher creatinine and lower GFR in the RSP group compared to the control group (p<0.001). At 5-years post-RSP initiation there was no significant worsening of renal function of the RSP group compared to the control group. In the RSP group after 5-years, the creatinine actually improved (creatinine decreased from 2.3 to 1.8 mg/dl) and the GFR increased (33.7 to 43.1 cc/min, see table). There was no significant difference in subsequent 5-year freedom from any-treated rejection between the two groups (p=0.373).

Conclusion: The use of RSP appears to prevent a decline of kidney function 5 years post-RSP initiation.

CITATION INFORMATION: Kittleson M., Patel J., Kransdorf E., Dimbil S., Levine R., Geft D., Chang D., Czer L., Sharoff R., Kobashigawa J. The Renal Sparing Protocol after Heart Transplant That Keeps Giving Am J Transplant. 2017;17 (suppl 3).

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