Pre-existing renal failure doubles 30-day mortality after heart transplantation.
BACKGROUND
Survival after cardiac transplantation has not changed over the last 10 years. Our objective was to identify risk factors for 30-day mortality after cardiac transplantation with particular reference to focusing on the impact of pre-existing renal dysfunction.


METHODS
We analyzed the data of all 1,180 patients who received a first heart transplant in the 8 adult transplant centers in the United Kingdom between April 1996 and March 2002 using the UK Cardiothoracic Transplant Audit database. Renal function at registration and transplantation was determined by calculation of creatinine clearance (CrCl) according to the Cockcroft-Gault formula.


RESULTS
Multivariate analysis showed that ventilator dependence pre-transplantation and cold ischemia time >4 hours had the highest association with 30-day mortality, followed by CrCl </=50 ml/min. Patients with a CrCl </=50 ml/min on day of transplantation had a significantly higher 30-day mortality compared to patients with CrCl >50 ml/min (19.7% vs 9.5%; p < 0.01). The change in CrCl between registration and transplantation was not related to mean CrCl or waiting time. In 67 of the patients with a CrCl >50 ml/min at registration, CrCl was reduced to </=50 ml/min on day of transplantation (30-day mortality 16.7%).


CONCLUSIONS
Pre-operative CrCl </=50 ml/min doubles the risk of death within 30 days after cardiac transplantation. Patients considered for cardiac transplantation should undergo regular measurement of renal function so that a more accurate risk-benefit assessment can be made.
Ostermann
Maria E
ME
Department of Renal Medicine and Transplantation, St. George's Hospital, London, UK. marlies@ostermann.freeserve.co.uk
Rogers
Chris A
CA
Saeed
Imran
I
Nelson
Stephen R
SR
Murday
Andrew J
AJ
D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications*; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors