Continuous renal replacement therapy after heart transplantation.
BACKGROUND
Renal failure following heart transplantation carries a poor prognosis. The objectives of this study were to determine risk factors for renal failure requiring continuous renal replacement therapy (CRRT), to describe the management strategies regarding immunosuppressive therapy and to examine the short-term prognosis.


METHODS
Fifty-six patients who underwent heart transplantation from 1998 to 2002 at the Montreal Heart Institute were retrospectively analyzed.


RESULTS
Six of 56 patients (11%) underwent CRRT after heart transplantation. Patients who underwent CRRT had lower preoperative creatinine clearance than those who did not (median 44 versus 59 mL/min, P=0.04) and lower first two-week postoperative creatinine clearance (median 23 versus 42 mL/min, P<0.01) compared with patients without CRRT. The total duration of CRRT ranged between two and 60 days (median 15 days). Cyclosporine was withheld for 12 days versus two days (P<0.01) and the time to achieve therapeutic levels of cyclosporine averaged 18 days versus nine days (P=0.01) among CRRT versus non-CRRT patients. Patients were administered thymoglobulin or basiliximab during cyclosporine withholding. The time to discharge from hospital after transplantation was longer in patients with CRRT (median 47 days versus 17 days, P<0.01). There was no mortality at three months in the CRRT group.


CONCLUSIONS
Creatinine clearance is an important predictor of renal failure requiring renal replacement therapy. Although renal failure remains a serious complication after transplantation, the use of CRRT and antilymphocyte agents during cyclosporine A withholding is associated with a favourable short-term prognosis following heart transplantation.
Stevens
Louis-Mathieu
LM
Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
El-Hamamsy
Ismaïl
I
Leblanc
Martine
M
Perrault
Louis P
LP
Pellerin
Michel
M
Bouchard
Denis
D
Carrier
Michel
M
D058186:Acute Kidney Injury / Q000209:etiology* / Q000378:metabolism / Q000628:therapy; D000328:Adult; D003404:Creatinine / Q000378:metabolism; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D017583:Hemodiafiltration; D006440:Hemofiltration; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged
D007166:Immunosuppressive Agents; D003404:Creatinine