Pre-operative renal function predicts development of chronic renal insufficiency after orthotopic heart transplantation.
BACKGROUND
Risk factors for the development of chronic renal insufficiency after solid-organ transplantation remain unclear.


METHODS
We conducted a 5-year retrospective analysis of all adult patients (n = 160) who survived >1 year after orthotopic heart transplantation at our institution from 1985 through 1992. Study subjects were classified into 3 groups based on peri-operative renal function: (1) pre-operative creatinine concentration <1.5 mg/dl and a post-operative (first 4 days) creatinine <2.0 mg/dl (n = 75); (2) pre-operative creatinine of <1.5 mg/dl but a post-operative creatinine of >2.0 mg/dl (n = 47); (3) pre-operative creatinine of >1.5 mg/dl (n = 38). The association between development of chronic renal insufficiency and peri-operative renal dysfunction was evaluated using the Cox proportional hazard model.


RESULTS
A total of 47 (29.4%) patients experienced chronic renal insufficiency (serial serum creatinine >2.0 mg/dl on 2 or more monthly examinations). The mean pre-operative serum creatinine was 1.6 mg/dl in patients who experienced chronic renal insufficiency, whereas it was 1.3 mg/dl in patients who did not (p < 0.01). The fraction of patients in whom chronic renal insufficiency developed was highest in Group 3 (55.3%), lower in Group 2 (25.5%), and lowest in Group 1 (18.7%) (p < 0.01). After adjusting for multiple potential confounding variables, including cyclosporine dosage, the risk of chronic renal insufficiency linearly decreased in the 3 groups, stratified by peri-operative renal function (relative risk, 1.82; 95% confidence interval, 1.23-2.7). However, the difference in relative risk of renal insufficiency was not statistically significant between Group 2 and Group 1.


CONCLUSIONS
Pre-operative serum creatinine concentration predicts development of renal insufficiency after heart transplantation.
Vossler
Mark R
MR
Oregon Cardiac Transplant Program, Division of Cardiology, Oregon Health Sciences University, Portland 97201, USA.
Ni
Hanyu
H
Toy
Warren
W
Hershberger
Ray E
RE
D000328:Adult; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood*; D016572:Cyclosporine / Q000008:administration & dosage; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000209:etiology / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine