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Predictors and evolution of renal function during 9 years following heart transplantation
Björn Lindelöw1, Claes-Håkan Bergh1, Hans Herlitz2
1Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Insights
Heart transplantation significantly impacts kidney function, with average GFR declining 44% over 9 years. Recipient age is a key predictor of long-term renal function post-transplant.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Heart transplantation is a life-saving procedure for end-stage heart failure.
- Renal dysfunction is a common and serious complication following heart transplantation.
- Understanding predictors of renal function decline is crucial for patient management.
Purpose of the Study:
- To evaluate the long-term changes in renal function after heart transplantation.
- To identify predictors of renal dysfunction and graft failure in heart transplant recipients.
- To assess the impact of preoperative renal function and specific medications on outcomes.
Main Methods:
- A 9-year retrospective study of 151 heart transplant recipients.
- Monitoring of renal function (GFR), hemodynamics, and cyclosporine A levels.
- Analysis of preoperative factors, medications, and development of severe renal dysfunction.
Main Results:
- Average GFR decreased by 44% from preoperative levels over 9 years post-transplantation.
- Recipient age was a significant predictor of renal function throughout the follow-up period.
- Severe renal dysfunction (GFR <20 ml/min/1.73 m²) developed in 20% of patients, predicted by age and 1-year GFR.
Conclusions:
- Significant, progressive renal function decline occurs after heart transplantation.
- Recipient age is a critical factor influencing long-term renal outcomes.
- A nomogram is presented to predict the risk of severe renal dysfunction post-transplant.
Abstract:
Over a 9-yr period, heart transplantation was performed in 200 patients at Sahlgrenska University Hospital. Of these 200 patients, 151 were followed for 1 to 9 yr with regard to renal function, hemodynamics, cyclosporin A concentrations, and complications. Patients with a preoperative serum creatinine >130 micromol/L received inotropic drugs to test for reversibility of renal dysfunction. The end point was graft failure. The average preoperative GFR of 66 +/- 17 ml/min per 1.73 m(2) declined to 52 +/- 19, 44 +/- 16, and 37 +/- 17 at 1, 5, and 9 yr after heart transplantation, respectively. Altogether, the average GFR declined by 44%. There was no significant correlation between the preoperative GFR and postoperative renal function or survival. Recipient age was a predictor of renal function during the entire follow-up. Severe renal dysfunction (GFR <20 ml/min per 1.73 m(2)) developed in 20% of the patients, which was predicted by the recipient age at transplantation together with the GFR 1 yr after transplantation. A nomogram that shows the risk of developing severe renal dysfunction after heart transplantation is presented. Cyclosporin A concentrations and treatment with statins, calcium channel blockers, or angiotensin-converting enzyme inhibitors did not correlate with the evolution of renal function. Patients with a preoperative depressed renal function who improved on inotropic treatment seemed to have a poorer outcome compared with the other study patients.