The effects of levosimendan on renal function early after heart transplantation: results from a pilot randomized trial

Authors

  • Ivan Knezevic,

    1. Advanced Heart Failure and Transplantation Center, UMC, Ljubljana, Slovenia
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  • Gregor Poglajen,

    1. Advanced Heart Failure and Transplantation Center, UMC, Ljubljana, Slovenia
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  • Eva Hrovat,

    1. Advanced Heart Failure and Transplantation Center, UMC, Ljubljana, Slovenia
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  • Anja Oman,

    1. Advanced Heart Failure and Transplantation Center, UMC, Ljubljana, Slovenia
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  • Tatjana Pintar,

    1. Advanced Heart Failure and Transplantation Center, UMC, Ljubljana, Slovenia
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  • Joseph C. Wu,

    1. Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA
    2. Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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  • Bojan Vrtovec,

    Corresponding author
    1. Advanced Heart Failure and Transplantation Center, UMC, Ljubljana, Slovenia
    2. Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA
    • Corresponding author: Bojan Vrtovec, MD, PhD, Advanced Heart Failure and Transplantation Center, Department of Cardiology, Ljubljana University Medical Center, Zaloska 7, MC SI-1000, Ljubljana, Slovenia.

      Tel.: +3861 522 2844; fax: +3861 522 2828; e-mail: bvrtovec@stanford.edu

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    • Both authors are equivalent senior authors of the study.
  • François Haddad

    1. Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA
    2. Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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    • Both authors are equivalent senior authors of the study.

  • Conflict of Interest: None.

Abstract

Background

We evaluated the effects of a levosimendan (LS)-based strategy compared with standard inotropic therapy on renal function in heart transplantation.

Methods and results

Using a randomized study design, 94 patients were assigned to LS-based therapy or standard inotropic support. At the time of transplantation, the groups did not differ in age, gender, heart failure etiology, hemodynamic profile, LVEF, or comorbidities. While there were no differences in serum creatinine (sCr) or eGFR between groups at baseline, patients in the LS group had a greater increase in their relative eGFR (62% vs. 12%, p = 0.002) and a lower incidence of acute kidney injury (AKI) (28% vs. 6%, p = 0.01) during the first post-transplant week. On logistic regression analysis, correlates of AKI were randomization to LS therapy (OR = 0.21 [0.09–0.62], p = 0.01), baseline renal dysfunction (OR = 3.9 [1.1–13.6], p = 0.032), and diabetes mellitus (OR = 4.2 [1.1–16.5], p = 0.038). However, LS was associated with a greater need for additional norepinephrine therapy (40 [85%] vs. 15 [31%], p < 0.001) and a trend toward longer intensive care unit stay (9.5 ± 9.0 d vs. 7.0 ± 6.0 d, p = 0.13).

Conclusions

In patients undergoing heart transplantation, levosimendan-based strategy may be associated with better renal function when compared to standard therapy.

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