Predictors and evolution of renal function during 9 years following heart transplantation.
Over a 9-yr period, heart transplantation was performed in 200 patients at Sahlgrenska University Hospital. Of these 200 patients, 151 were followed for 1 to 9 yr with regard to renal function, hemodynamics, cyclosporin A concentrations, and complications. Patients with a preoperative serum creatinine >130 micromol/L received inotropic drugs to test for reversibility of renal dysfunction. The end point was graft failure. The average preoperative GFR of 66 +/- 17 ml/min per 1.73 m(2) declined to 52 +/- 19, 44 +/- 16, and 37 +/- 17 at 1, 5, and 9 yr after heart transplantation, respectively. Altogether, the average GFR declined by 44%. There was no significant correlation between the preoperative GFR and postoperative renal function or survival. Recipient age was a predictor of renal function during the entire follow-up. Severe renal dysfunction (GFR <20 ml/min per 1.73 m(2)) developed in 20% of the patients, which was predicted by the recipient age at transplantation together with the GFR 1 yr after transplantation. A nomogram that shows the risk of developing severe renal dysfunction after heart transplantation is presented. Cyclosporin A concentrations and treatment with statins, calcium channel blockers, or angiotensin-converting enzyme inhibitors did not correlate with the evolution of renal function. Patients with a preoperative depressed renal function who improved on inotropic treatment seemed to have a poorer outcome compared with the other study patients.
Lindelöw
Björn
B
Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Bergh
Claes-Håkan
CH
Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Herlitz
Hans
H
Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden.
Waagstein
Finn
F
Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D016019:Survival Analysis; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine