Risk factors associated with moderate-to-severe renal dysfunction among heart transplant patients: results from the...

Area of Science:

• Nephrology
• Cardiology
• Immunology

Background:

• Long-term survival following heart transplantation (HT) is associated with an increased incidence of calcineurin inhibitor-related chronic kidney disease (CKD).
• Identifying risk factors for CKD in HT recipients is crucial for patient management and improving long-term outcomes.

Purpose of the Study:

• To identify independent risk factors for moderate-to-severe renal dysfunction (MSRD), defined as K/DOQI stage 3 CKD or worse, in adult heart transplant recipients.

Main Methods:

• A cohort of 1062 adult HT patients from 14 Spanish centers was analyzed.
• Glomerular filtration rate (GFR) was estimated using the MDRD equation.
• Multivariate logistic regression was employed to identify predictors of MSRD.

Main Results:

• Over 60% of patients exhibited MSRD at a mean follow-up of 6.7 years post-transplant.
• Independent predictors of MSRD included male sex (protective), higher pre- and post-transplant creatinine, older age at transplant, longer time since transplant, and tacrolimus use (protective).
• Conversely, female sex, higher creatinine, older age, longer time since transplant, and cyclosporine use were identified as risk factors for CKD stage 3 or worse.

Conclusions:

• Female sex, elevated serum creatinine, older age at transplant, longer duration post-transplant, and immunosuppression with cyclosporine are significant risk factors for developing CKD stage 3 or worse in heart transplant recipients.
• These findings highlight the importance of monitoring renal function and considering alternative immunosuppressive strategies in at-risk HT patients.