Natural course and risk factors for impaired renal function during the first year after heart transplantation
published online 29 March 2010.
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 m2). 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 m2; 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 (<1,000 ml), pre-operative pacemaker implantation, intubation time >24 hours, pre-operative GFR <60 ml/min/1.73 m2, post-operative troponin T >6 μg/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.
aDepartment of Cardiothoracic Surgery, Helsinki University Hospital, Helsinki, Finland
bCardiopulmonary Research Group, Transplantation Laboratory, University of Helsinki, Helsinki, Finland
cDivision of Respiratory Diseases, Department of Medicine, Helsinki University Hospital, Helsinki, Finland
dDepartment of Anesthesiology, Helsinki University Hospital, Helsinki, Finland
eDivision of Cardiology, Department of Medicine, Helsinki University Hospital, Helsinki, Finland
Reprint requests: Janne J. Jokinen, MD, PhD, Department of Cardiothoracic Surgery, Helsinki University Hospital, P.O. Box 340, Helsinki FI-00029, Finland. Telephone: +358-50-554-8103. Fax: +358-9-471-74475
ABSTRACT