scholarly journals Renal functional reserve in kidney and heart transplant recipients.

1996 ◽  
Vol 7 (8) ◽  
pp. 1145-1152
Author(s):  
J L Ader ◽  
I Tack ◽  
D Durand ◽  
T Tran-Van ◽  
L Rostaing ◽  
...  
Keyword(s):  
Amino Acid ◽  
Heart Transplant ◽  
Sympathetic Innervation ◽  
Graft Function ◽  
Transplant Recipients ◽  
Functional Reserve ◽  
Acid Infusion ◽  
Amino Acid Infusion ◽  
Renal Functional Reserve ◽  
Heart Transplant Recipients

Renal functional impairment paradoxically often seems less severe in kidney than in heart-transplant recipients (KTR and HTR, respectively) when both are submitted to cyclosporine therapy. Renal functional reserve (RFR), elicited by a 3-h intravenous amino acid infusion, was examined in 12 KTR and 13 HTR at 7 to 8 months, appropriately compared with either eight one-kidney or 12 two-kidney healthy control subjects (1K.C and 2K.C, respectively). Baseline GFR was 54 +/- 4 mL/min in KTR and 71 +/- 4 mL/min in HTR (P < 0.05). During amino acid infusion, the maximum increase in GFR (which represented RFR) was 17 +/- 3 mL/min in both KTR and HTR (P < 0.001). RFR in KTR was 96 +/- 18% of that in 1K.C, whereas RFR in HTR was only 59 +/- 9% of that in 2K.C. Effective RPF increased (41 +/- 8 mL/min, P < 0.001), and renal vascular resistances decreased (48 +/- 17 mm Hg/L per min, P < 0.05) in KTR but not in HTR. These results demonstrate that both KTR and HTR possess a renal reserve but that the single renal graft in KTR retains a proportionally higher baseline GFR and a better ability to exhibit a RFR than the two native kidneys in HTR. This dissimilar impairment could result from slightly higher cyclosporine dosage, activation of the intact renal sympathetic innervation accentuated by cardiac denervation, renal consequences of former heart failure and potential alterations in the cardiac graft function, and/or higher prevalence of hypertension and additive therapies in HTR.

scholarly journals Assessment of renal functional reserve with intravenous amino acid infusion in children with various renal deseases.

1998 ◽  
Vol 11 (1) ◽  
pp. 103-107
Author(s):  
Takayuki Kasahara ◽  
Takayoshi Okugawa ◽  
Hiroshi Hayakawa ◽  
Naoyuki Kabuki ◽  
Souichirou Ookubo ◽  
...  
Keyword(s):  
Amino Acid ◽  
Functional Reserve ◽  
Acid Infusion ◽  
Amino Acid Infusion ◽  
Renal Functional Reserve

Renal functional reserve: from physiological phenomenon to clinical biomarker and beyond

2020 ◽  
Vol 319 (6) ◽  
pp. R690-R702 ◽  
Author(s):  
Alemayehu H. Jufar ◽  
Yugeesh R. Lankadeva ◽  
Clive N. May ◽  
Andrew D. Cochrane ◽  
Rinaldo Bellomo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Amino Acids ◽  
Acute Kidney Injury ◽  
Amino Acid ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Functional Reserve ◽  
Acid Infusion ◽  
Amino Acid Infusion ◽  
Renal Functional Reserve

Glomerular filtration rate (GFR) is acutely increased following a high-protein meal or systemic infusion of amino acids. The mechanisms underlying this renal functional response remain to be fully elucidated. Nevertheless, they appear to culminate in preglomerular vasodilation. Inhibition of the tubuloglomerular feedback signal appears critical. However, nitric oxide, vasodilator prostaglandins, and glucagon also appear important. The increase in GFR during amino acid infusion reveals a “renal reserve,” which can be utilized when the physiological demand for single nephron GFR increases. This has led to the concept that in subclinical renal disease, before basal GFR begins to reduce, renal functional reserve can be recruited in a manner that preserves renal function. The extension of this concept is that once a decline in basal GFR can be detected, renal disease is already well progressed. This concept likely applies both in the contexts of chronic kidney disease and acute kidney injury. Critically, its corollary is that deficits in renal functional reserve have the potential to provide early detection of renal dysfunction before basal GFR is reduced. There is growing evidence that the renal response to infusion of amino acids can be used to identify patients at risk of developing either chronic kidney disease or acute kidney injury and as a treatment target for acute kidney injury. However, large multicenter clinical trials are required to test these propositions. A renewed effort to understand the renal physiology underlying the response to amino acid infusion is also warranted.

179: Interplay between Graft-Function and Intravascular Deposition of C4d in Heart Transplant Recipients

2010 ◽  
Vol 29 (2) ◽  
pp. S64-S64
Author(s):  
F. Fabbri ◽  
T. Ionico ◽  
L. Potena ◽  
P. Prestinenzi ◽  
G. Magnani ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Graft Function ◽  
Transplant Recipients ◽  
Heart Transplant Recipients

Association between routine measures of graft function and mortality in heart transplant recipients

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318721
Author(s):  
Farid Foroutan ◽  
Abdullah Malik ◽  
Lærke Marie Sidenius Nelson ◽  
Chun-Po Fan Steve ◽  
Gordon Guyatt ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Graft Function ◽  
Left Ventricular ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Transplant Recipients ◽  
Graft Dysfunction ◽  
Ventricular Ejection Fraction ◽  
Post Transplant ◽  
Heart Transplant Recipients

ObjectiveTo date, long-term graft dysfunction, an important cause of death after heart transplantation, has been defined as a left ventricular ejection fraction (LVEF) of ≤40% or right atrial pressure (RAP) of ≥15 mm Hg. Empirical associations between measures of cardiac function and mortality post-transplant remain, however, unestablished.MethodsWe conducted a retrospective two-centre cohort study of consecutive adults who underwent heart transplant between 2002 and 2017. We evaluated the association between LVEF and RAP and mortality, including rejection and cardiac allograft vasculopathy as additional time-dependent covariates using Cox proportional hazard models. We applied restricted cubic splines to both LVEF and RAP.ResultsOf 590 eligible heart transplant recipients, of whom 72% were male with a mean age of 49 years, 410 received their transplant at Toronto General Hospital and 180 at Rigshospitalet. We observed a 5% absolute risk increase for 1-year mortality, from 11% to 16%, when the LVEF dropped to 53% (HR 1.71 for LVEF of 53% compared with 60%, 95% CI 1.36 to 2.14) or when the RAP increased to 12 mm Hg (HR 1.49 for RAP of 12 mm Hg compared with 5 mm Hg, 95% CI 1.04 to 2.13).ConclusionIn this study, we observed that small changes in graft function at any time post-transplant are associated with an increased mortality. Our results suggest that the current definition of graft dysfunction may underestimate patient risk of adverse outcomes.

Antibody-mediated rejection is associated with impaired graft function in pediatric heart transplant recipients

2015 ◽  
Vol 34 (8) ◽  
pp. 1120-1121 ◽  
Author(s):  
Kenneth R. Knecht ◽  
Ashley Glover ◽  
Amy M. Dossey ◽  
Mallik Rettiganti ◽  
Jeffrey Gossett ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Graft Function ◽  
Transplant Recipients ◽  
Antibody Mediated Rejection ◽  
Heart Transplant Recipients ◽  
Pediatric Heart Transplant

scholarly journals The Role of Echocardiography in the Management of Heart Transplant Recipients

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2338
Author(s):  
Daniele Masarone ◽  
Michelle Kittleson ◽  
Rita Gravino ◽  
Fabio Valente ◽  
Andrea Petraio ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Graft Function ◽  
Transplant Recipients ◽  
Antibody Mediated Rejection ◽  
Non Invasive ◽  
Comprehensive Information ◽  
Versatile Tool ◽  
Heart Transplant Recipients ◽  
And Function

Transthoracic echocardiography is the primary non-invasive modality for the investigation of heart transplant recipients. It is a versatile tool that provides comprehensive information on cardiac structure and function. Echocardiography is also helpful in diagnosing primary graft dysfunction and evaluating the effectiveness of therapeutic approaches for this condition. In acute rejection, echocardiography is useful with suspected cellular or antibody-mediated rejection, with findings confirmed and quantified by endomyocardial biopsy. For identifying chronic rejection, ultrasound has a more significant role and, in some specific patients (e.g., patients with renal failure), it may offer a role comparable to coronary angiography to identify cardiac allograft vasculopathy. This review highlights the usefulness of echocardiography in evaluating normal graft function and its role in the management of heart transplant recipients.

210 Efficacy and safety of Mycophenolate Mofetil in Chagas' heart transplant recipients

2006 ◽  
Vol 5 (1) ◽  
pp. 40-40
Author(s):  
R BESTETTI ◽  
T THEODOROPOULOS ◽  
T SOUZA ◽  
M LIMA ◽  
E BURDMANN ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Heart Transplant ◽  
Efficacy And Safety ◽  
Transplant Recipients ◽  
Heart Transplant Recipients
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