Acute renal failure early after heart transplantation: risk factors and clinical consequences

Abstract

Limited information exists about acute renal failure (ARF) early after heart transplantation (HTx). We correlated pre-, per-, and post-operative patient and donor parameters to the risk of developing ARF. We also analyzed the consequences of ARF on kidney function after HTx, risk of later need for chronic dialysis or kidney transplantation, and mortality. In a retrospective study from 1983 to 2007, 145 (25%) of 585 HTx recipients developed ARF, defined as ≥ 26.4 micromol/L or ≥ 50% increase in serum creatinine from pre-operatively to the seventh day post-HTx and/or the need of early post-operative dialysis. Independent risk factors for ARF were intravenous cyclosporine immediately post-operatively (odds ratio [OR] 2.16, 95% CI 1.34-3.50, p = 0.02), donor age (OR 1.02, 95% CI 1.00-1.04, p = 0.02), and pre-operative cardiac output (OR 1.38, 95% CI 1.12-1.71, p = 0.003). The development of ARF was a predictor for short-term survival (≤ 3 months) ranging from 98% for patients who improved their creatinine after HTx vs. 79% for those in need of dialysis (p < 0.001). However, ARF did not predict subsequent end stage renal disease in need of dialysis or renal transplantation. ARF is a common complication post-HTx. As ARF is associated with short-term survival, post-operative strategies of preserving renal function have the potential of reducing mortality. Of avoidable risk factors, the use of intravenous CsA should be discouraged.

Acute Kidney Disease After Liver and Heart Transplantation

“…15 Independent risk factors for AKI were intravenous cyclosporine immediately postoperatively (OR, 2.16; 95% CI, 1.34-3.50; P = 0.02), donor age (OR, 1.02; 95% CI, 1.00-1.04; P = 0.02), and preoperative cardiac output (OR, 1.38; 95% CI, 1.12-1.71; P = 0.003). Lastly, AKI was a predictor of 3-month survival (P < 0.001).…”

Untitled

“…Gude and associates reported that, as preoperative hemodynamics improve over time, better preoperative renal function may be observed over the years. 2 The limitations of our study resulted from it being a retrospective, single-center study that enrolled a small number of patients.…”

“…1 Despite significant improvements in both short-and long-term mortality; however, medical complications after OCT contribute to significant morbidity and mortality in these patients. 2,3 Orthotopic cardiac transplant recipients are vulnerable to developing acute kidney dysfunction. [3][4][5] The incidence of acute kidney dysfunction after OCT ranges from 6.0% to 70.4% of patients, of whom 28% to 85% require renal replacement therapy.…”

Atualização da Diretriz Brasileira de Insuficiência Cardíaca Crônica - 2012

“…Quanto aos pacientes alossensibilizados, que apresentam painel linfocitário acima de 10%, o transplante somente será indicado após prova cruzada prospectiva negativa. As contraindicações estão resumidas na Tabela 25 169,[182][183][184][185] . Avaliação multidisciplinar é fundamental para o sucesso de transplante 168 .…”