Risk stratification for renal transplantation after cardiac or lung transplantation: single-center experience and review of the literature.
BACKGROUND
Long-term survival after heart (HTx) or lung (LuTx) transplantation increases the risk for end-stage renal disease (ESRD). After HTx ESRD was reported to enhance mortality, and kidney transplantation (KTx) was shown to improve survival. However, prognostic factors in ESRD after HTx or LuTx are largely unknown.


METHODS
Single-center observational study in HTx and LuTx patients who accessed the KTx waiting list; baseline characteristics were correlated with mortality.


RESULTS
KTx was performed in 15 of 65 study patients. Survival was comparable on the KTx waiting list and in reference patients from the same center without ESRD. KTx significantly improved survival (5 years' survival 84.6% with KTx vs. 56.5% on the KTx waiting list, p = 0.030). None of the baseline parameters predicted mortality in the KTx group. Only on the KTx waiting list BMI (median 24.7 vs. 20.7; p < 0.05) and left ventricular ejection fraction (LVEF, median 63 vs. 53%, p < 0.008) significantly correlated with survival.


CONCLUSIONS
The risk for mortality after HTx or LuTx is not increased by ESRD, provided that patients meet access criteria for the KTx waiting list. KTx improves survival in ESRD after HTx or LuTx. BMI and LVEF may predict outcome in HTx/LuTx patients on the KTx waiting list.
Rosenberger
Christian
C
Nephrology and Medical Intensive Care, Charité Universitätsmedizin, Berlin, Germany. chrosenbe@aol.com <chrosenbe@aol.com>
Stein
Julia
J
Jürgensen
Jan Steffen
JS
Eibl
Nermin
N
Babel
Nina
N
Bachmann
Ulrike
U
Kemper
Dagmar
D
Knosalla
Christoph
C
Hetzer
Roland
R
Frei
Ulrich
U
Lehmkuhl
Hans
H
Reinke
Petra
P
D000328:Adult; D000368:Aged; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality* / Q000639:trends; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality* / Q000639:trends; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality* / Q000639:trends; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors