title: Predictors of renal dysfunction at 1 year in heart transplant patients.
abstract: BACKGROUND
  Renal dysfunction (RD) is one of the most significant long-term complications of heart transplantation (HT). Although RD is generally attributed to a direct effect of calcineurin inhibitors, it is more probable that multiple factors contribute to its development. The aim of this study was to search for predictor variables of RD at 1 year after HT.
  
  
  METHODS
  Three hundred sixteen consecutive HT patients were evaluated. The relationship between RD at 1 year (glomerular filtration rate <60 mL/min/1.73 m2), and pretransplant and 1-year follow-up variables was analyzed.
  
  
  RESULTS
  At 1 year following HT, 181 patients (57%) had a glomerular filtration rate of <60 mL/min/1.73 m2. On multivariate analysis, pretransplant serum creatinine values (odds ratio [OR] 5.106, 95% confidence interval [CI]: 2.35-11.09, P=0.0001) and cytomegalovirus (CMV) infection (OR 2.04, 95% CI: 1.08-3.83, P=0.027) were significant predictors of RD, and diabetes mellitus was almost significant (OR 1.65, 95% CI: 0.98-2.76, P=0.055). Variables protective against RD were induction therapy with interleukin-2 receptor antagonists versus muromonab-CD3 (OR 0.389, 95% CI: 0.24-0.61, P=0.0001), maintenance treatment with mycophenolate mofetil versus azathioprine (OR 0.42, 95% CI: 0.26-0.68, P=0.0001), and CMV antiviral prophylaxis (OR 0.38, 95% CI: 0.17-0.68, P=0.021).
  
  
  CONCLUSIONS
  Fifty-seven percent of HT patients had RD at 1 year posttransplant. RD was associated with pretransplant serum creatinine values, CMV infection, and diabetes mellitus. Induction with interleukin-2 receptor antagonists, treatment with mycophenolate mofetil, and antiviral prophylaxis for CMV infection all helped maintain renal function in this cohort of HT patients.
authors.affiliation: Department of Cardiology, Heart Failure and Transplant Unit, La Fe University Hospital, Valencia, Spain. villacampus@hotmail.com
authors.forename: Josep
authors.initials: J
authors.lastname: Navarro-Manchón
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Dolz
authors.forename: Luis
authors.initials: L
authors.lastname: Almenar Bonet
authors.forename: Ignacio
authors.initials: I
authors.lastname: Sánchez-Lázaro
authors.forename: Rafael
authors.initials: R
authors.lastname: Raso Raso
authors.forename: Esther Zorio
authors.initials: EZ
authors.lastname: Grima
authors.forename: Jaime
authors.initials: J
authors.lastname: Agüero Ramon-Llin
authors.forename: Francisco
authors.initials: F
authors.lastname: Buendía Fuentes
authors.forename: Juan-Miguel
authors.initials: JM
authors.lastname: Sánchez-Gómez
authors.forename: Antonio
authors.initials: A
authors.lastname: Salvador Sanz
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D003586:Cytomegalovirus Infections / Q000150:complications; D003928:Diabetic Nephropathies / Q000209:etiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007668:Kidney / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D007166:Immunosuppressive Agents; D003404:Creatinine