Clinical consequences after heart transplantation with reference to osteoporosis, renal function, and immunosuppression. Experiences from Skåne University Hospital in Lund 1988-2019.
Author
Summary, in English
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/s
Publishing year
2021
Language
English
Publication/Series
Lund University, Faculty of Medicine Doctoral Dissertation Series
Issue
2021:127
Document type
Dissertation
Publisher
Lund University, Faculty of Medicine
Topic
- Cardiac and Cardiovascular Systems
- Endocrinology and Diabetes
Keywords
- Heart Transplantation
- Osteoporosis
- chronic kidney disase
- immunosuppressive agents
Status
Published
Research group
- Lund Hemodynamic Lab
Supervisor
ISBN/ISSN/Other
- ISSN: 1652-8220
- ISBN: 978-91-8021-134-5
Defence date
10 December 2021
Defence time
13:15
Defence place
Segerfalksalen, BMC A10, Sölvegatan 17 i Lund. Join by Zoom: https://lu-se.zoom.us/j/64306007983
Opponent
- Howard J. Eisen (Professor, MD)