Natural course and risk factors for impaired renal function during the first year after heart transplantation

作者：Jokinen Janne J^*; Tikkanen Jussi; Kukkonen Sinikka; Hammainen Pekka; Lommi Jyri; Sipponen Jorma; Lemstrom Karl B

来源：Journal of Heart and Lung Transplantation, 2010, 29(6): 633-640.

DOI：10.1016/j.healun.2010.01.004

• heart transplantation
• renal function
• immunosuppression
• glomerular filtration rate
• 4-MDRD equation

BACKGROUND: Post-operative renal failure is a common and potentially hazardous complication after heart transplantation (HTx). In this study we characterized pre- and post-operative risk factors for acute renal failure requiring renal replacement therapy (RRT).
METHODS: Ninety-three patients underwent orthotopic HTx between 2000 and 2007. The risk factors for RRT during the early post-operative period and predictors contributing to impaired renal function within the first post-transplant year were analyzed by regression analysis. The impact of pre-operative renal failure and early post-operative RRT on renal function within 1 year were studied.
RESULTS: Before HTx, 55% of patients (51 of 93) had normal renal function or mild renal failure (glomerular filtration rate [GFR] >60 ml/min/1.73 m(2)). Before discharge from the hospital, 25% (23 of 93) developed acute renal failure and required RRT. Of these, 16% (8 of 51) had pre-operatively normal renal function or mild renal failure, and 36% (15 of 42) had moderate or severe renal failure (GFR <60 ml/min/1.73 m(2); p = 0.02). The prognosticators for early RRT were prolonged graft dysfunction, re-admission to the operating room due to post-operative bleeding, poor diuresis during surgery (<1,0(X) ml), pre-operative pacemaker implantation, intubation time >24 hours, pre-operative GFR <60 ml/min/1.73 m(2), post-operative troponin T >6 mu g/liter and pre-operative use of angiotensin receptor blocker.
CONCLUSIONS: Pre-operative renal failure is a significant risk factor for RRT during the immediate post-operative period and requires aggressive treatment. Patients with pre-operative renal failure secondary to severe heart failure and acute post-operative renal failure requiring RRT tend to recover within the first year post-HTx.

• 出版日期2010-6