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Background. Chronic kidney disease (CKD) is a complication of heart transplantation related to calcineurin inhibitor nephrotoxicity. However, it is unclear whether early ciclosporin (CsA) exposure influences CKD in the long term. Methods. We analysed risk factors for CKD in 352 patients who underwent orthotopic heart transplantation (1995–2005). In 2000, we reduced our target CsA levels in the first year after transplantation. Results. Actuarial patient survival was 79% at 1 year and 62% at 10 years. Estimated median glomerular filtration rate (eGFR) by the four-variable Modification of Diet in Renal Disease formula was 64 ml/min/1.73 m2 before transplantation, inter-quartile range (IQR) 54–78. After transplantation, the eGFR was 48 (IQR 37–61) at Year 1, and 41(35–57) at Year 10. The cumulative probability of eGFR P P = 0.005; increasing recipient age, P P = 0.029; female donor, P = 0.04, but not CsA regimen. The cumulative probability of developing stage 5 CKD (eGFR P = 0.008), there was no significant effect by Year 3 (P = 0.7). Conclusion. The incidence of CKD increased with time and was not influenced by the CsA regimen. Some risk factors are not modifiable but measures to reduce the incidence of post-operative ARF may help to reduce CKD. [ABSTRACT FROM AUTHOR]