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Published on: April 12, 2021
Prediction of Kidney Function Improvement After Heart Transplantation
Jakub Ptak1,2, Mateusz Sokolski1,2, Mateusz Wilk3,4
1Institute of Heart Diseases, Jan Mikulicz Radecki University Hospital Wroclaw, 50556 Wroclaw, Poland.
Insights
Kidney function improvement after heart transplantation (HTx) is uncommon. Predictors include higher preoperative bilirubin and avoiding renal replacement therapy (RRT) early post-HTx, suggesting benefit in severe cardiorenal syndrome cases.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Medicine
Background:
- Advanced heart failure (HF) frequently co-occurs with impaired kidney function, a condition known as cardiorenal syndrome.
- Heart transplantation (HTx) is a potential intervention to restore renal function in select HF patients.
- Identifying predictors of renal function improvement post-HTx is crucial for patient selection and management.
Purpose of the Study:
- To identify predictors of kidney function improvement within the first three months after heart transplantation.
- To analyze the relationship between preoperative patient characteristics and postoperative renal function changes.
Main Methods:
- Retrospective analysis of heart transplant recipients divided into improvement, deterioration, and no significant change groups based on estimated glomerular filtration rate (eGFR) changes.
- Multivariate analysis to determine independent predictors of improved renal function.
Main Results:
- Higher preoperative total bilirubin levels (OR 1.66) and not requiring renal replacement therapy (RRT) early post-HTx (OR 0.46) were independent predictors of improved kidney function.
- Patients who improved showed higher preoperative blood urea and total bilirubin levels, and more frequent use of inotropes/vasopressors.
Conclusions:
- Renal function improvement after HTx is not common but can be anticipated in patients with severe cardiorenal syndrome.
- Patients with impaired kidney and liver function, but not requiring immediate RRT post-HTx, may experience renal recovery.
Abstract:
Background/Objectives: Patients with advanced heart failure (HF) often suffer from impaired kidney function. Based on the pathophysiology of types I and II of cardiorenal syndrome, heart transplantation (Htx) may restore renal function. The aim of this study was to identify predictors of improvement in kidney function after HTx. Methods: Htx patients from a tertiary hospital were retrospectively divided into three groups-improvement (n = 24), deterioration (n = 31) and no significant change in eGFR (n = 45)-based on changes in their mean estimated glomerular filtration rate (eGFR) within the first three postoperative months, compared to the last three preoperative months. The threshold for eGFR improvement was defined as a ≥20% increase, while deterioration was defined as a ≥20% decrease. The no significant change group was defined as any change falling between these two values. Results: The median age of analyzed cohort was 54 (45-63) years, and 82% were male. Preoperatively, the improvement group was more frequently treated with inotropes or vasopressors and had significantly higher blood urea and total bilirubin levels before Htx. In the multivariate analysis, total bilirubin before Htx (OR 1.66; 95% CI; 1.24-2.69; p = 0.002) and no need for RRT early after Htx (OR 0.46; 95% CI 0.24-0.88; p = 0.02) were independent predictors of improved kidney function in the first three months after HTx. Conclusions: The improvement in renal function after HTx is uncommon. It could be expected in patients suffering from more severe forms of HF, with impaired kidney and liver function but who did not need RRT after the surgery.
