Prognostic importance of renal function 1 year after heart transplantation for all-cause and cardiac mortality and development of allograft vasculopathy.
BACKGROUND
Impaired renal function is associated with increased mortality among heart failure patients. Although a significant proportion of heart transplant (HTx) recipients have reduced renal function at 1 year post-HTx, no previous study has evaluated the associated risk for both all-cause and cardiac mortality. Hence, we assessed the relationship between glomerular filtration rate (GFR) at 1 year post-HTx and all-cause and cardiac mortality and development of cardiac allograft vasculopathy (CAV).


METHODS
We evaluated 381 patients with a minimum survival of 1 year post-HTx and the Modification of Diet in Renal Disease Study formula was used to calculate estimated GFR. Mortality and angiographic CAV were defined as separate endpoints, and median follow-up was 7.4 and 4.0 years, respectively.


RESULTS
During the follow-up period, 122 patients died and 154 patients developed CAV. Reduced GFR pre-HTx was not a risk factor for either endpoint. Overall, 193 (51%) patients had GFR <60 ml/min/1.73 m at one year post-HTx and this was an independent predictor of all-cause mortality with an adjusted hazard ratio of 1.7 (P=0.01) for a GFR between 30-60 and 3.2 (P=0.006) for GFR <30 ml/min/1.73 m. GFR <60 ml/min/1.73 m at 1 year post-HTx was also associated with a higher risk of cardiac mortality (HR=1.9; P=0.04) but did not predict the development of CAV.


CONCLUSIONS
Renal impairment is evident in a majority of HTx recipients at 1 year post-HTx. It is an important risk factor for both all-cause and cardiac mortality but does not predict the development of angiographic CAV.
Department of Cardiology, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway. satish.arora@medisin.uio.no
Satish
S
Arora
Arne
A
Andreassen
Svein
S
Simonsen
Einar
E
Gude
Christen
C
Dahl
Rita
R
Skaardal
Ina
I
Hoel
Odd
O
Geiran
Lars
L
Gullestad
D000328:Adult; D002423:Cause of Death; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous