Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study

Abstract

Acute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term survival and risk factors of dialysis were investigated. Patients who had undergone dialysis were stratified to early or late dialysis for subgroup analysis. The mean follow-up was five years, the incidence of dialysis was 28.4% (21% early dialysis and 7.4% late dialysis). The dialysis cohort had higher overall mortality compared with the non-dialysis cohort. The hazard ratios of mortality in patients with dialysis were 3.44 (95% confidence interval (CI), 2.73–4.33) for all dialysis patients, 3.58 (95% CI, 2.74–4.67) for early dialysis patients, and 3.27 (95% CI, 2.44–4.36; all p < 0.001) for late dialysis patients. Patients with diabetes mellitus, chronic kidney disease, acute kidney injury, and coronary artery disease were at higher risk of renal failure requiring dialysis. Cardiomyopathy, hepatitis B virus infection, and hyperlipidemia treated with statins were associated with a lower risk of renal dysfunction requiring early dialysis. The use of Sirolimus and Mycophenolate mofetil was associated with a lower incidence of late dialysis. Renal dysfunction requiring dialysis after heart transplantation is common in Taiwan. Early and late dialysis were both associated with an increased risk of mortality in heart transplant recipients.

Determinants of Outcomes of Acute Kidney Injury: Clinical Predictors and Beyond

“…AKI, especially AKI-D, is common and is associated with serious complications after both cardiovascular and non-cardiac surgery [ 51 ]. Patients who require dialysis after surgery may have higher rates of mortality and kidney non-recovery [ 52 , 53 ].…”

Pathogenetic mechanisms, epidemiology and classification of acute kidney injury in heart transplant recipients

“…Факторы риска возникновения ОПП при трансплантации сердца были изучены множеством авторов. К предоперационным относятся предсуществующая почечная дисфункция, сахарный диабет, старший возраст как донора, так и реципиента, предшествующие трансплантации сердца; к интра-и послеоперационным: продолжительность ишемии трансплантата, операции и ИК, большая кровопотеря и объемные гемотрансфузии, механическая поддержка кровообращения, функциональная недостаточность сердечного трансплантата [69][70][71] [73][74][75].…”

Risk Factors for Acute Kidney Injury Requiring Renal Replacement Therapy after Orthotopic Heart Transplantation in Patients with Preserved Renal Function

“…A recent meta-analysis showed that incidences of AKI (according to KDIGO criteria) and AKI requiring renal replacement therapy (RRT) after HTX were 62.8% and 11.8%, respectively [3]. AKI post-HTX was associated with reduced long-term and 1-year patient survival [3,4]. In addition, AKI requiring RRT led to massive impairments regarding the patient's quality of life [4,5].…”