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Renal function and outcome after heart transplantation

Journal article
Authors Oscar Kolsrud
Kristjan Karason
Erik Holmberg
Sven-Erik Ricksten
Marie Felldin
Ola Samuelsson
Göran Dellgren
Published in Journal of Thoracic and Cardiovascular Surgery
Volume 155
Issue 4
Pages 1593-1604.e1
ISSN 0022-5223
Publication year 2018
Published at Institute of Clinical Sciences, Department of Oncology
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 1593-1604.e1
Language en
Links doi.org/10.1016/j.jtcvs.2017.11.087
Keywords acute renal failure, chronic renal failure, heart transplantation, kidney function, acute kidney failure, adult, aged, all cause mortality, Article, artificial ventilation, chronic kidney failure, clinical outcome, comparative study, controlled study, diabetes mellitus, end stage renal disease, estimated glomerular filtration rate, female, follow up, glomerulus filtration rate, human, kidney graft, long term survival, major clinical study, male, overall survival, postoperative period, preoperative care, preoperative evaluation, priority journal, prognosis, renal replacement therapy, surgical mortality, surgical patient, surgical risk
Subject categories Surgery, Cardiovascular medicine, Thoracic surgery

Abstract

Objectives: To investigate whether measured glomerular filtration rate (mGFR) is a risk factor for death and/or end-stage renal disease (ESRD) after heart transplantation (HTx). Methods: All adult patients (n = 416) who underwent HTx between 1988 and 2010 were included. mGFR was performed both preoperatively and postoperatively as annual follow-up. Eight patients received a concomitant kidney transplant (KTx), and 15 underwent late KTx due to chronic renal failure after HTx. Results: The mean drop in mGFR compared with the preoperative value was 12% during the first year after HTx. Preoperative mGFR was not predictive of mortality or ESRD. Older or the use of a ventricular assist device (VAD) were preoperative predictors of death. Long-term survival was significantly worse in the patients who experienced a >25% decrease in mGFR during the first year after transplantation. The need for acute postoperative renal replacement therapy (RRT) was associated with impaired survival but did not predict ESRD among survivors. On multivariable analyses, previous heart surgery, preoperative VAD, and a lower mGFR were all predictors of RRT. In the most recent period, death without previous ESRD was lower, and the only preoperative factors associated with ESRD by multivariable analyses were mechanical ventilation and diabetes mellitus. Conclusions: Pretransplantation mGFR was not predictive of mortality or ESRD after HTx, but necessitated simultaneous or late-stage KTx in this selected population of patients. However, patients with a decrease in >25% mGFR during the first year post-transplantation, as well as early postoperative dialysis-dependent acute renal dysfunction, had a poor prognosis. We suggest that patients with severely impaired kidney function, irrespective of pretransplantation renal function, still should be considered for HTx, but also encourage careful interpretation of our results given the selection bias involved in this population.

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