The Clinical Impact of an Early Decline in Kidney Function in Patients Following Heart Transplantation

Abstract

Renal dysfunction is a well-known complication following heart transplantation. We examined an early decline in kidney function as a predictor of progression to end-stage renal disease and mortality in heart transplant recipients. We performed a retrospective cohort study of 233 patients who received a heart transplant between July 1985 and July 2004, and who survived >1 month. The decline in estimated creatinine clearance (CrCl) was used to predict the outcomes of need for chronic dialysis or mortality >1-year posttransplant. The earliest time to chronic dialysis was 484 days. A 30% decline in CrCl between 1 month and 12 months predicted the need for chronic dialysis (p = 0.01), all-cause mortality (p < 0.0001) and time to first CrCl ≤30 mL/min at >1-year posttransplant (p = 0.02). A 30% decline in CrCl between 1 month and 3 months also independently predicted the need for chronic dialysis (p = 0.04) and time to first CrCl ≤ 30 mL/min at >1-year posttransplant (p = 0.01). In conclusion, an early drop in CrCl within the first year is a strong predictor of chronic dialysis and death >1-year postheart transplantation. Future studies should focus on kidney function preservation in those identified at high risk for progression to end-stage kidney disease and mortality.

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

“…HTx recipients have an increased risk of developing ARF (5,6,9,14), previously mainly defined as the need for early post-operative dialysis, with an incidence varying from 5.8% to 12.7% (5,6,9) These data might seem to differ from our own. However, in an effort to pick up lesser changes in creatinine post-HTx and adapt our findings to recently published AKIN criteria (12), our incidence of 25% includes moderate increases in creatinine (group 3) and those in need of dialysis (group 4).…”

Determinants of renal impairment in heart transplant recipients: The ischaemic cardiomyopathy group is more prone to adverse renal outcome

“…This was most severe in the first six months and is possibly associated with early adverse outcome. This is consistent with findings of other investigators [25,26]. Some researchers have reported the period of rapid decline to be as long as two years [8,9].…”

Incidence, Determinants, and Outcome of Chronic Kidney Disease After Adult Heart Transplantation in the United Kingdom

“…Despite the different mechanisms involved, preoperative renal dysfunction was significantly associated with posttransplantation CKD. We also found that patients whose renal function deteriorated rapidly in the first 3 months posttransplantation were at increased risk, reflecting other studies which found that a fall in renal function in the first year had an impact on later CKD (17,18,21,26).…”