Hypertension as a marker for later development of end-stage renal failure after lung and heart-lung transplantation: a cohort study.
BACKGROUND
Time to renal failure after transplantation is not well known and the prognosis of lung and heart-lung transplantation with respect to end-stage renal failure and related factors has not been investigated in detail. We determined the predictors of end-stage renal failure after lung or heart-lung transplant using multivariate analysis.


METHODS
A cohort study of 115 adult patients transplanted between 1990 and 1995, who survived at least 5 years, was carried out. Characteristics and clinical findings, including blood pressure, creatinine clearance and immunosuppression levels of patients with end-stage renal failure, were compared with those without, initially in a univariate analysis. Then a multivariate logistic regression model was built to examine the association of predictor variables with end-stage renal failure after adjustment for confounding.


RESULTS
There were 19 of 115 (16.4%) patients with end-stage renal failure, with an average time of loss of renal function of 7.6 years (95% confidence interval [CI] 6.5 to 8.7) after transplantation. There was no difference in survival between patients with end-stage renal failure and those without. Multivariate analysis showed that development of hypertension post-operatively was the only significant predictor variable (odds ratio 8.16, 95% CI 1.01 to 66.0, p = 0.04). Patients' age at transplantation, gender, underlying medical conditions and other post-transplant features were not associated with end-stage renal failure.


CONCLUSIONS
Development of hypertension after lung or heart-lung transplant should be used a marker for later development of end-stage renal failure. Any hypertension should be treated energetically. Acute renal failure immediately post-operatively did not predict end-stage renal failure in this cohort of patients.
Department of Transplant Medicine, Harefield and Royal Brompton Hospitals, London, UK.
H
H
Kunst
D
D
Thompson
M
M
Hodson
D000328:Adult; D015331:Cohort Studies; D005260:Female; D016041:Heart-Lung Transplantation; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007165:Immunosuppression Therapy; D007676:Kidney Failure, Chronic / Q000209:etiology*; D007677:Kidney Function Tests; D016040:Lung Transplantation; D008297:Male; D015999:Multivariate Analysis; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors