Independent predictors of renal dysfunction after heart transplantation in patients with normal pretransplant renal function.
BACKGROUND
Renal dysfunction (RD) is a common complication after heart transplantation (HT), but predictors of post-HT RD have not been clearly identified.


METHODS
We studied 262 HT patients (mean age 54 years, 221 men) with normal baseline renal function. Potential risk factors examined were age, sex, pre-HT ischemic cardiomyopathy, pre- and post-HT diabetes mellitus, pre- and post-HT arterial hypertension, initial immunosuppressive protocol (before 1998 [high cyclosporine, azathioprine, and prednisone] vs after 1998 [low cyclosporine, mycophenolate mofetil, and prednisone]), occurrence of rejection episodes > or =ISHLT Grade 3A, and creatinine level 1 month after HT. RD was considered mild if creatinine level was 1.5 to 2.5 mg/dl, moderate if creatinine level was >2.5 mg/dl, and severe if dialysis or kidney transplant was required.


RESULTS
The cumulative incidence of RD (creatinine >1.5 mg/dl) was 35% at 12 months, 42% at 24 months, and 47% at 60 months (mean follow-up 59 +/- 31 months). Only 1% of patients had severe RD 60 months after HT. Independent predictors of RD 24 months after HT were older age (odds ratio [OR] 1.1 [95% confidence interval (95% CI) 1.0-1.1]; p = 0.001), male sex (OR 3.3 [95% CI 1.3-8.1]; p = 0.008), pre-1998 immunosuppressive protocol (OR 2.8 [95% CI 1.4-5.4]; p = 0.003), and creatinine level 1 month after HT (OR 3.2 [95% CI 1.0-5.4]; p < 0.0001).


CONCLUSIONS
The cumulative incidence of RD in HT patients treated with calcineurin inhibitors increased with time after HT. Age, male sex, an immunosuppressive protocol with relatively high cyclosporine levels and creatinine level 1 month after HT were independent predictors of the presence of RD 24 months after HT.
Garrido
I P
IP
Heart Transplant Programme, Juan Canalejo University Hospital, A Coruña, Spain. irisgarrido@secardiologia.es
Crespo-Leiro
M G
MG
Paniagua
M J
MJ
Muñiz
J
J
Vázquez-Rey
E
E
Pérez-Fernández
R
R
García-Lara
J
J
Cuenca-Castillo
J J
JJ
Castro-Beiras
A
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects; D048909:Diabetes Complications; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine