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Murine Renal Transplantation Procedure
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Renal function and outcome after heart transplantation.

Oscar Kolsrud1, Kristjan Karason2, Erik Holmberg3

  • 1Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

The Journal of Thoracic and Cardiovascular Surgery
|January 18, 2018
PubMed
Summary

Pretransplant kidney function (mGFR) doesn't predict death or ESRD post-heart transplant. However, a significant drop in mGFR or acute kidney injury within the first year indicates a poor prognosis for heart transplant recipients.

Keywords:
acute renal failurechronic renal failureheart transplantationkidney function

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Area of Science:

  • Cardiology
  • Nephrology
  • Transplantation Medicine

Background:

  • Heart transplantation (HTx) outcomes are influenced by multiple factors.
  • Assessing pre-existing kidney function is crucial for patient selection and post-transplant management.

Purpose of the Study:

  • To determine if measured glomerular filtration rate (mGFR) is a risk factor for mortality or end-stage renal disease (ESRD) after heart transplantation (HTx).

Main Methods:

  • A cohort of 416 adult patients undergoing HTx between 1988 and 2010 were analyzed.
  • Measured glomerular filtration rate (mGFR) was assessed preoperatively and annually postoperatively.
  • Outcomes including mortality, ESRD, and need for renal replacement therapy (RRT) were recorded.

Main Results:

  • Preoperative mGFR did not predict mortality or ESRD. Older age and ventricular assist device (VAD) use predicted death.
  • A decrease in mGFR >25% within the first year post-HTx was associated with significantly worse long-term survival.
  • Acute postoperative renal replacement therapy (RRT) predicted impaired survival but not ESRD among survivors.

Conclusions:

  • Pretransplantation mGFR is not a predictor of mortality or ESRD post-HTx, though it may necessitate kidney transplantation.
  • A significant decline in mGFR or acute kidney dysfunction post-HTx indicates a poor prognosis.
  • Patients with impaired kidney function should still be considered for HTx, with careful consideration of potential biases.