本研究為回溯性世代研究，年代久遠，但是病人腎功能數據幾無遺漏，其他 相關變項遺漏值多在 1%以下；移植前高血脂遺漏值百分比 6.2%，屬可接受範圍。
限制有：一、由於移植術後腎功能變化進展至需要長期洗腎或死亡都需要長 時間，所以除去死亡及長期透析病人，有 16.4%病人追蹤時間尚未滿五年。部分 病人追蹤時間還不到五年；由於樣本數夠大，且限縮在五年內的變化情形作描述，
應在合理範圍內。二、在探討相關變項與腎臟功能變化的關係，僅對只收集文獻 查證後有意義變項做討論，未來研究可盡量包含各種可能的變項來做討論。三、
由於收案的可近性，本研究對象僅限單一醫學中心的病人，研究結果推論到其他 醫院時應審慎解讀。
腎臟功能不全在心臟移植病人有逐年上升的變化趨勢，在不同研究時放入的 各種危險因子變項與所採用的研究對象與族群各有不同，因此會產生許多不同的 結果，此為第一份國內直接使用臨床數據描述心臟移植病人腎功能的變化，及可 能的風險因素初探，結果和國外其他的研究報告差異不大。希望未來研究能再納 入更多的國內資料，並要盡量包含各種可能的變項，及足夠的時間追蹤，找出這 些造成腎臟功能下降的危險因子之間的關係與各因子對慢性腎臟疾病的權重，掌 握變化趨勢，才能夠研究發展延緩腎功能惡化的措施，發展本土性整體計畫。
56
參考資料
Al Aly, Z., Abbas, S., Moore, E., Diallo, O., Hauptman, P. J., & Bastani, B. (2005). The natural history of renal function following orthotopic heart transplant. Clinical Transplantation, 19(5), 683-689.
Alam, A., Badovinac, K., Ivis, F., Trpeski, L., & Cantarovich, M. (2007). The Outcome of Heart Transplant Recipients Following the Development of End‐Stage Renal Disease: Analysis of the Canadian Organ Replacement Register (CORR).
American Journal of Transplantation, 7(2), 461-465.
Alonso, E. M. (2004). Long‐term renal function in pediatric liver and heart recipients.
Pediatric transplantation, 8(4), 381-385.
Armitage, J. M., Fricker, F. J., del Nido, P., Starzl, T. E., Hardesty, R. L., & Griffith, B.
P. (1993). A decade (1982 to 1992) of pediatric cardiac transplantation and the impact of FK 506 immunosuppression. J Thorac Cardiovasc Surg, 105(3), 464.
Arora, S., Andreassen, A., Simonsen, S., Gude, E., Dahl, C., Skaardal, R., . . .
Gullestad, L. (2007). Prognostic importance of renal function 1 year after heart transplantation for all-cause and cardiac mortality and development of allograft vasculopathy. Transplantation, 84(2), 149-154.
Arora, S., Gude, E., Sigurdardottir, V., Mortensen, S. A., Eiskjæ r, H., Riise, G., . . . Jansson, K. (2012). Improvement in renal function after everolimus
introduction and calcineurin inhibitor reduction in maintenance thoracic
transplant recipients: the significance of baseline glomerular filtration rate. The Journal of Heart and Lung Transplantation, 31(3), 259-265.
Bauer, J., Thul, J., Krämer, U., Hagel, K., Akintürk, H., Valeske, K., . . . Schranz, D.
(2001). Heart transplantation in children and infants: Short‐term outcome and long‐term follow‐up. Pediatric transplantation, 5(6), 457-462.
Bertani, T., Ferrazzi, P., Schieppati, A., Ruggenenti, P., Gamba, A., Parenzan, L., . . . Remuzzi, G. (1991). Nature and extent of glomerular injury induced by
cyclosporine in heart transplant patients. Kidney international, 40(2), 243-250.
Boissonnat, P., Gaillard, S., Mercier, C., Redonnet, M., Lelong, B., Mattei, M.-F., . . . Epailly, E. (2012). Impact of the early reduction of cyclosporine on renal function in heart transplant patients: a French randomised controlled trial.
Trials, 13(1), 231.
Bourge, R. C., Naftel, D. C., Costanzo-Nordin, M. R., Kirklin, J., Young, J. B., Kubo, S. H., . . . Kasper, E. (1993). Pretransplantation risk factors for death after heart transplantation: a multiinstitutional study. Journal of Heart and Lung
Transplantation, 12(4), 549-562.
57
Boyer, O., Le Bidois, J., Dechaux, M., Gubler, M.-C., & Niaudet, P. (2005).
Improvement of renal function in pediatric heart transplant recipients treated with low-dose calcineurin inhibitor and mycophenolate mofetil.
Transplantation, 79(10), 1405-1410.
Boyle, J. M., Moualla, S., Arrigain, S., Worley, S., Bakri, M. H., Starling, R. C., . . . Thakar, C. V. (2006). Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation. American Journal of Kidney Diseases, 48(5), 787-796.
Brisco, M. A., Kimmel, S. E., Coca, S. G., Putt, M. E., Jessup, M., Tang, W. W., . . . Testani, J. M. (2014). Prevalence and prognostic importance of changes in renal function after mechanical circulatory support. Circulation: Heart Failure, 7(1), 68-75.
Butler, J., Geisberg, C., Howser, R., Portner, P. M., Rogers, J. G., Deng, M. C., &
Pierson, R. N. (2006). Relationship between renal function and left ventricular assist device use. The Annals of thoracic surgery, 81(5), 1745-1751.
Canver, C., Heisey, D., & Nichols, R. (2000). Acute renal failure requiring
hemodialysis immediately after heart transplantation portends a poor outcome.
The Journal of cardiovascular surgery, 41(2), 203-206.
Cassuto, J. R., Reese, P. P., Sonnad, S., Bloom, R. D., Levine, M. H., Olthoff, K., . . . Abt, P. (2010). Wait list death and survival benefit of kidney transplantation among nonrenal transplant recipients. American Journal of Transplantation, 10(11), 2502-2511.
Chen, J. W., Lin, C. H., & Hsu, R. B. (2014). Incidence, risk factor, and prognosis of end-stage renal disease after heart transplantation in Chinese recipients. J Formos Med Assoc, 113(1), 11-16. doi: 10.1016/j.jfma.2012.04.012
Cirillo, M., De Santo, L. S., Pollastro, R. M., Romano, G., Mastroiacono, C., Maiello, C., . . . Anastasio, P. (2005). Creatinine clearance and hemoglobin
concentration before and after heart transplantation. Paper presented at the Seminars in nephrology.
Davies, R. R., Sorabella, R. A., Yang, J., Mosca, R. S., Chen, J. M., & Quaegebeur, J.
M. (2012). Outcomes after transplantation for “failed” Fontan: a
single-institution experience. J Thorac Cardiovasc Surg, 143(5), 1183-1192.
e1184.
De Santo, L. S., Romano, G., Amarelli, C., Maiello, C., Baldascino, F., Bancone, C., . . . Nappi, G. (2011). Implications of acute kidney injury after heart transplantation:
what a surgeon should know. European Journal of Cardio-Thoracic Surgery, 40(6), 1355-1361.
58
Delgado, J. F., Crespo-Leiro, M. G., Gómez-Sánchez, M. A., Paniagua, M. J., González-Vílchez, F., Vázquez de Prada, J. A., . . . Muñiz, J. (2010). Risk factors associated with moderate-to-severe renal dysfunction among heart transplant patients: results from the CAPRI study. Clinical Transplantation, 24(5), E194-E200.
Delgado, J. F., Crespo‐Leiro, M. G., Gómez‐Sánchez, M. A., Paniagua, M. J.,
González‐Vílchez, F., Vázquez de Prada, J. A., . . . Martínez‐Dolz, L. (2010).
Risk factors associated with moderate‐to‐severe renal dysfunction among heart transplant patients: results from the CAPRI study. Clinical Transplantation, 24(5), E194-E200.
Deuse, T., Haddad, F., Pham, M., Hunt, S., Valantine, H., Bates, M., . . . Reitz, B.
(2008). Twenty‐Year Survivors of Heart Transplantation at Stanford University.
American Journal of Transplantation, 8(9), 1769-1774.
Devineni, R., McKenzie, N., Keown, P., Kostuk, W., Stiller, C., & Silver, M. (1984).
Cyclosporine in cardiac transplantation. Canadian journal of surgery. Journal canadien de chirurgie, 27(3), 252-254.
English, R. F., Pophal, S. A., Bacanu, S. A., Fricker, J., Boyle, G. J., Ellis, D., . . . Law, Y. M. (2002). Long‐Term Comparison of Tacrolimus‐and Cyclosporine‐
Induced Nephrotoxicity in Pediatric Heart‐Transplant Recipients. American Journal of Transplantation, 2(8), 769-773.
Flechner, S. M., Kobashigawa, J., & Klintmalm, G. (2008). Calcineurin inhibitor‐
sparing regimens in solid organ transplantation: focus on improving renal function and nephrotoxicity. Clinical Transplantation, 22(1), 1-15.
Garrido, I., Crespo-Leiro, M., Paniagua, M., Muñiz, J., Vázquez-Rey, E.,
Pérez-Fernández, R., . . . Castro-Beiras, A. (2005). Independent predictors of renal dysfunction after heart transplantation in patients with normal
pretransplant renal function. The Journal of Heart and Lung Transplantation, 24(9), 1226-1230.
Gonwa, T., Mai, M., Pilcher, J., Johnson, C., Pierson, S., Capehart, J., & Alivizatos, P.
(1991). Stability of long-term renal function in heart transplant patients treated with induction therapy and low-dose cyclosporine. The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation, 11(5), 926-928.
González-Vílchez, F., Arizón, J., Segovia, J., Almenar, L., Crespo-Leiro, M., Palomo, J., . . . Pérez-Villa, F. (2014). Chronic renal dysfunction in maintenance heart transplant patients: the ICEBERG study. Paper presented at the Transplantation proceedings.
59
González-Vílchez, F., & de Prada, J. A. V. (2014). Chronic Renal Insufficiency in Heart Transplant Recipients: Risk Factors and Management Options. Drugs, 74(13), 1481-1494.
Goral, S., Ynares, C., Shyr, Y., Yeoh, T., & Johnson, H. (1997). Long-term renal function in heart transplant recipients receiving cyclosporine therapy. The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation, 16(11), 1106-1112.
Greenberg, A., Egel, J. W., Thompson, M. E., Hardesty, R. L., Griffith, B. P., Bahnson, H. T., . . . Puschett, J. B. (1987). Early and late forms of cyclosporine
nephrotoxicity: studies in cardiac transplant recipients. American Journal of Kidney Diseases, 9(1), 12-22.
Gude, E., Andreassen, A. K., Arora, S., Gullestad, L., Grov, I., Hartmann, A., . . . Vardal, M. (2010). Acute renal failure early after heart transplantation: risk factors and clinical consequences. Clinical Transplantation, 24(6), E207-E213.
Hamour, I. M., Omar, F., Lyster, H. S., Palmer, A., & Banner, N. R. (2009). Chronic kidney disease after heart transplantation. Nephrol Dial Transplant, 24(5), 1655-1662.
Herlitz, H., & Lindelöw, B. (2000). Renal failure following cardiac transplantation.
Nephrology Dialysis Transplantation, 15(3), 311-314.
Hornung, T. S., de Goede, C. G., O'Brien, C., Moghal, N. E., Dark, J. H., & O'Sullivan, J. J. (2001). Renal function after pediatric cardiac transplantation: the effect of early cyclosporin dosage. Pediatrics, 107(6), 1346-1350.
Hoskote, A., & Burch, M. (2014). Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children. Pediatr Nephrol. doi: 10.1007/s00467-014-2878-4
Hoskote, A., Carter, C., Rees, P., Elliott, M., Burch, M., & Brown, K. (2010). Acute right ventricular failure after pediatric cardiac transplant: predictors and long-term outcome in current era of transplantation medicine. J Thorac Cardiovasc Surg, 139(1), 146-153.
Hunt, J., Lerman, M., Magee, M. J., Dewey, T. M., Herbert, M., & Mack, M. J. (2005).
Improvement of renal dysfunction by conversion from calcineurin inhibitors to sirolimus after heart transplantation. The Journal of Heart and Lung
Transplantation, 24(11), 1863-1867.
Jokinen, J. J., Tikkanen, J., Kukkonen, S., Hämmäinen, P., Lommi, J., Sipponen, J., &
Lemström, K. B. (2010). Natural course and risk factors for impaired renal function during the first year after heart transplantation. The Journal of Heart and Lung Transplantation, 29(6), 633-640.
60
Karamlou, T., Welke, K. F., McMullan, D. M., Cohen, G. A., Gelow, J., Tibayan, F.
A., . . . Song, H. K. (2014). Combined heart-kidney transplant improves post-transplant survival compared with isolated heart transplant in recipients with reduced glomerular filtration rate: Analysis of 593 combined heart-kidney transplants from the United Network Organ Sharing Database. J Thorac
Cardiovasc Surg, 147(1), 456-461. e451.
Kobashigawa, J., Miller, L., Russell, S., Ewald, G., Zucker, M., Goldberg, L., . . . Gao, J. (2006). Tacrolimus with Mycophenolate Mofetil (MMF) or Sirolimus vs.
Cyclosporine with MMF in Cardiac Transplant Patients: 1‐Year Report.
American Journal of Transplantation, 6(6), 1377-1386.
Kopp, J. B., & Klotman, P. E. (1990). Cellular and molecular mechanisms of cyclosporin nephrotoxicity. Journal of the American Society of Nephrology, 1(2), 162-179.
Kunst, H., Thompson, D., & Hodson, M. (2004). Hypertension as a marker for later development of end-stage renal failure after lung and heart-lung transplantation:
a cohort study. The Journal of Heart and Lung Transplantation, 23(10), 1182-1188.
Kurpesa, M., Trzos, E., Wierzbowska-Drabik, K., & Rechciński, T. (2010). Ivabradine as a heart rate-lowering agent in a patient with end-stage renal failure after heart transplantation. Kardiologia polska, 68(6), 684-686.
Lachance, K., White, M., Carrier, M., Mansour, A., Racine, N., Liszkowski, M., . . . de Denus, S. (2014). Long-term evolution, secular trends, and risk factors of renal dysfunction following cardiac transplantation. Transplant International, 27(8), 824-837.
LAMAS, S. (2005). Cellular mechanisms of vascular injury mediated by calcineurin inhibitors. Kidney international, 68(2), 898-907.
Lanese, D. M., & Conger, J. D. (1993). Effects of endothelin receptor antagonist on cyclosporine-induced vasoconstriction in isolated rat renal arterioles. Journal of Clinical Investigation, 91(5), 2144.
Levey, A. S., & Coresh, J. (2012). Chronic kidney disease. The Lancet, 379(9811), 165-180. doi: http://dx.doi.org/10.1016/S0140-6736(11)60178-5
Lewis, R., Van Buren, C., Radovancevic, B., Frazier, O., Janney, R., Powers, P., . . . Kerman, R. (1990). Impact of long-term cyclosporine immunosuppressive therapy on native kidneys versus renal allografts: serial renal function in heart and kidney transplant recipients. The Journal of heart and lung transplantation:
the official publication of the International Society for Heart Transplantation, 10(1 Pt 1), 63-70.
61
LINDELÖ W, B., BERGH, C.-H., Herlitz, H., & Waagstein, F. (2000). Predictors and evolution of renal function during 9 years following heart transplantation.
Journal of the American Society of Nephrology, 11(5), 951-957.
Lund, L. H., Edwards, L. B., Kucheryavaya, A. Y., Dipchand, A. I., Benden, C., Christie, J. D., . . . Yusen, R. D. (2013). The Registry of the International Society for Heart and Lung Transplantation: thirtieth official adult heart transplant report—2013; focus theme: age. The Journal of Heart and Lung Transplantation, 32(10), 951-964.
Manito, N., Rábago, G., Palomo, J., Arizón, J., Delgado, J., Almenar, L., . . . Pulpón, L.
(2011). Improvement in chronic renal failure after mycophenolate mofetil introduction and cyclosporine dose reduction: four-year results from a cohort of heart transplant recipients. Paper presented at the Transplantation
proceedings.
Molina, E. J., Sandusky, M. F., Gupta, D., Gaughan, J. P., McClurken, J. B., Furukawa, S., & Macha, M. (2010). Outcomes after heart transplantation in patients with and without pretransplant renal dysfunction. Scandinavian Cardiovascular Journal, 44(3), 168-176.
Myers, B. D., Ross, J., Newton, L., Luetscher, J., & Perlroth, M. (1984).
Cyclosporine-Associated Chronic Nephropathy. New England Journal of Medicine, 311(11), 699-705.
Naesens, M., Kuypers, D. R., & Sarwal, M. (2009). Calcineurin inhibitor
nephrotoxicity. Clinical Journal of the American Society of Nephrology, 4(2), 481-508.
Ojo, A. O., Held, P. J., Port, F. K., Wolfe, R. A., Leichtman, A. B., Young, E. W., . . . Merion, R. M. (2003). Chronic renal failure after transplantation of a nonrenal organ. New England Journal of Medicine, 349(10), 931-940.
Porter, G. A., Bennett, W. M., & Sheps, S. G. (1990). Cyclosporine-associated hypertension. Archives of internal medicine, 150(2), 280-283.
Pouteil-Noble, C., Hemdawy, A., Villar, E., Boissonnat, P., & Sebbag, L. (2005).
Chronic renal failure and end-stage renal disease are associated with a high rate of mortality after heart transplantation. Paper presented at the
Transplantation proceedings.
Rice, J. E., Shipp, A. T., Carlin, J. B., Vidmar, S. I., & Weintraub, R. G. (2002). Late reduction in cyclosporine dosage does not improve renal function in pediatric heart transplant recipients. The Journal of Heart and Lung Transplantation, 21(10), 1109-1112.
62
Ruggenenti, P., Perico, N., Mosconi, L., Gaspari, F., Benigni, A., Amuchastegui, C.
S., . . . Remuzzi, G. (1993). Calcium channel blockers protect transplant patients from cyclosporine-induced daily renal hypoperfusion. Kidney international, 43, 706-706.
Sandner, S. E., Zimpfer, D., Zrunek, P., Rajek, A., Schima, H., Dunkler, D., . . . Wieselthaler, G. M. (2009). Renal function and outcome after continuous flow left ventricular assist device implantation. The Annals of thoracic surgery, 87(4), 1072-1078.
Scherrer, U., Vissing, S. F., Morgan, B. J., Rollins, J. A., Tindall, R. S., Ring, S., . . . Victor, R. G. (1990). Cyclosporine-induced sympathetic activation and hypertension after heart transplantation. New England Journal of Medicine, 323(11), 693-699.
Stehlik, J., Edwards, L., Kucheryavaya, A., Benden, C., Christie, J., Dipchand, A., . . . Hertz, M. (2012). International Society of Heart and Lung Transplantation. The registry of the International Society for Heart and Lung Transplantation: 29th official adult heart transplant report--2012. J Heart Lung Transplant, 31(10), 1052-1064.
Strologo, L. D., Parisi, F., Legato, A., Pontesilli, C., Pastore, A., Ravà, L., . . . Rizzoni, G. (2006). Long-term renal function in heart transplant children on
cyclosporine treatment. Pediatr Nephrol, 21(4), 561-565.
Türker, M., Zeyneloglu, P., Sezgin, A., Pirat, A., & Arslan, G. (2013). RIFLE criteria for acute kidney dysfunction following heart transplantation: incidence and risk factors. Paper presented at the Transplantation proceedings.
Taylor, D. O., Barr, M. L., Radovancevic, B., Renlund, D. G., Mentzer Jr, R. M., Smart, F. W., . . . VanVeldhuisen, P. (1999). A randomized, multicenter comparison of tacrolimus and cyclosporine immunosuppressive regimens in cardiac
transplantation: decreased hyperlipidemia and hypertension with tacrolimus.
The Journal of Heart and Lung Transplantation, 18(4), 336-345.
Thomas, H. L., Banner, N. R., Murphy, C. L., Steenkamp, R., Birch, R., Fogarty, D.
G., . . . Steering Group of the, U. K. C. T. A. (2012). Incidence, determinants, and outcome of chronic kidney disease after adult heart transplantation in the United Kingdom. Transplantation, 93(11), 1151-1157.
Tinawi, M., Miller, L., & Bastani, B. (1997). Renal function in cardiac transplant recipients: retrospective analysis of 133 consecutive patients in a single center.
Clinical Transplantation, 11(1), 1-8.
63
Van Buren, D. H., Burke, J. F., & Lewis, R. M. (1994). Renal function in patients receiving long-term cyclosporine therapy. Journal of the American Society of Nephrology, 4(8), S17.
van Gelder, T., Balk, A., Zietse, R., Hesse, C., Mochtar, B., & Weimar, W. (1998).
Renal insufficiency after heart transplantation: a case-control study. Nephrology Dialysis Transplantation, 13(9), 2322-2326.
Villar, E., Boissonnat, P., Sebbag, L., Hendawy, A., Cahen, R., Trolliet, P., . . . Pouteil-Noble, C. (2007). Poor prognosis of heart transplant patients with end-stage renal failure. Nephrology Dialysis Transplantation, 22(5), 1383-1389.
Wilkinson, A. H., & Cohen, D. J. (1999). Renal failure in the recipients of nonrenal solid organ transplants. Journal of the American Society of Nephrology, 10(5), 1136-1144.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., . . . Januzzi, J. L. (2013). 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 62(16), e147-e239.
Zietse, R., Balk, A., vd Dmpel, M., Meeter, K., Mochtar, B., Bos, E., & Weimar, W.
(1994). Time-course of the decline in renal function in cyclosporine treated heart transplant recipients. CLINICAL ASPECTS OF HEART
TRANSPLANTATION, 181.
吳岳霖, &陳錫賢. (2012). 腎功能之評估: 由血液生化檢查值觀點. 腎臟與透析,