Acute renal failure requiring hemodialysis immediately after heart transplantation portends a poor outcome.
BACKGROUND
Previous studies have not provided a definite clarification for the predictive value of pretransplant renal indices on postcardiac transplant patient outcome. Therefore, the purpose of this study was to investigate the interaction between pretransplant renal function and recovery after heart transplantation.


METHODS
The study group consisted of 199 consecutive patients who underwent heart transplantation between 1973 and 1994. For better comparison, patients were arbitrarily divided into three different groups based on the year of the transplant operation: Group I- before 1985 (n=13), Group II- between 1985 and 1989 (n=68) and Group III- between 1990 and 1994 (n=118). Values for serum creatinine (Cr), blood urea nitrogen (BUN), urea/creatinine ratio (U/Cr), creatinine clearance (Cr(cl)), length of hospital stay (LOS), early (30-day) mortality, and survival at 1-year and at 5-year were collected for each patient. The data was analyzed by the use of univariate log-rank test with forward stepwise procedure.


RESULTS
Postcardiac transplant LOS in the hospital or survival was unaffected by the pretransplant renal indices except the U/Cr ratio (p>0.05). When adjusted for the time, the U/Cr ratio was also insignificant (p=0.1349). The use of hemodialysis was necessary in 9 patients (4.5%) for treatment of acute renal failure manifested immediately after the transplant operation. Early mortality was 44% for these 9 cardiac transplant recipients who required the use of hemodialysis: 0% (0/3) in the 1985-1989 period and 67% (4/6) in the 1990-1994 period.


CONCLUSIONS
Pretransplant renal indices have no predictive value on outcome after a heart transplant operation, however, postcardiac transplant acute renal failure necessitating hemodialysis portends a poor outcome.
Canver
C C
CC
Division of Cardiothoracic Surgery, Albany Medical College, New York 12208, USA.
Heisey
D M
DM
Nichols
R D
RD
D058186:Acute Kidney Injury / Q000209:etiology / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000378:metabolism; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014508:Urea / Q000378:metabolism
D014508:Urea; D003404:Creatinine