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Published on: April 27, 2019
Prognostic Factors of Renal Outcomes after Heart Transplantation: A Nationwide Retrospective Study
Junseok Jeon1, Hyejeong Park2, Youngha Kim2
1Division of Nephrology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06531, Korea.
Insights
Perioperative renal replacement therapy (RRT) after heart transplantation (HT) predicts poor kidney outcomes, including end-stage kidney disease (ESKD). Early renoprotective strategies are crucial for heart transplant recipients.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Renal dysfunction significantly impacts survival post-heart transplantation (HT).
- Identifying predictors of renal outcomes is crucial for improving patient prognosis after HT.
Purpose of the Study:
- To investigate predictive factors for renal outcomes following heart transplantation.
- To analyze nationwide cohort data to understand the long-term renal impact of HT.
Main Methods:
- Retrospective cohort study utilizing the Health Insurance Review and Assessment database of Korea.
- Analysis of 654 patients who underwent HT between 2008 and 2016 and survived until discharge.
- Evaluation of perioperative factors, including renal replacement therapy (RRT), inotropes/vasopressors, ACEi/ARB use, and pre-existing conditions.
Main Results:
- 1.8% of patients developed end-stage kidney disease (ESKD) during a median follow-up of 2.8 years.
- Perioperative RRT lasting over 3 weeks, use of inotropes/vasopressors, and non-use of ACEi/ARB were associated with ESKD.
- Among patients without pre-existing chronic kidney disease (CKD), 18.5% developed CKD, associated with age, extracorporeal membrane oxygenation, and RRT.
Conclusions:
- Perioperative renal replacement therapy is a significant predictor of adverse renal outcomes after heart transplantation.
- Pre-existing renal disease, prolonged RRT, and specific medication use are linked to poor renal prognosis.
- Implementing active renoprotective strategies during the perioperative period is essential for heart transplant recipients.
Abstract:
Renal dysfunction after heart transplantation (HT) is associated with poor survival. We investigated the predictive factors of renal outcomes after HT using nationwide cohort data. In this retrospective cohort study using the Health Insurance Review and Assessment database of Korea, 654 patients who received HT between 2008 and 2016 and survived until discharge after HT were analyzed. The median (interquartile range) age was 52 (40-60) years, and 68.1% were male. Perioperative renal replacement therapy (RRT) was performed in 27.8% of patients. During 2.8 years of median followup, end-stage kidney disease (ESKD) developed in 12 patients (1.8%). In a fully adjusted model, RRT > 3 weeks, the use of inotropes/vasopressors and non-use of ACEi/ARB were associated with ESKD. Preexisting renal disease tended to be associated with ESKD. Among the 561 patients without preexisting CKD, 104 (18.5%) developed chronic kidney disease (CKD). Age, extracorporeal membrane oxygenation, and RRT were associated with the development of CKD after HT. Our nationwide cohort study demonstrated that perioperative RRT was a predictor of poor renal outcomes after HT. These results suggest that an active renoprotective strategy is required during the perioperative period.
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