title: Impact of renal function before mechanical circulatory support on posttransplant renal outcomes.
abstract: BACKGROUND
  Renal dysfunction is common before mechanical circulatory support (MCS). Mechanical circulatory support frequently improves renal function, but the impact of pre-MCS renal dysfunction on renal function after cardiac transplantation (CTX) is unknown.
  
  
  METHODS
  Patients with MCS from January 1995 until April 2008 at a single center were included if their MCS duration was at least 60 days and they underwent successful CTX. Patients were followed for 1 year after CTX.
  
  
  RESULTS
  A total of 116 patients were included in the study. Mechanical circulatory support was biventricular assist device in 28% and left ventricular assist device in 72% (continuous flow left ventricular assist device, 14%). Mean duration of MCS was 124 days. Patients were grouped according to tertiles of pre-MCS creatinine clearance (CrCl): group 1, CrCl less than 45 mL/min; group 2, CrCl between 45 and 65 mL/min inclusive; and group 3, CrCl more than 65 mL/min. Group 3 had the best renal outcomes both after MCS and 1 year after CTX. Regardless of group, patients who had a CrCl of at least 60 mL/min before CTX had similar 1-year posttransplant CrCl (55 versus 53 versus 56 mL/min for groups 1 through 3, respectively; not significantly different). However, the ability to achieve this level of renal function after MCS was less likely in those with the worst renal function before the initiation of MCS (53% versus 74% versus 90% for groups 1 through 3, respectively; p=0.001).
  
  
  CONCLUSIONS
  The use of MCS leads to improvements in renal function in patients after MCS. However, the renal outcomes after CTX seem to be more dependent on the level of renal function achieved during MCS than on the level of renal function before MCS.
authors.affiliation: Cardiovascular Institute, Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Madhurmeet
authors.initials: M
authors.lastname: Singh
authors.forename: Michael
authors.initials: M
authors.lastname: Shullo
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kormos
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lockard
authors.forename: Rachelle
authors.initials: R
authors.lastname: Zomak
authors.forename: Marc A
authors.initials: MA
authors.lastname: Simon
authors.forename: Christian
authors.initials: C
authors.lastname: Bermudez
authors.forename: Jay
authors.initials: J
authors.lastname: Bhama
authors.forename: Dennis
authors.initials: D
authors.lastname: McNamara
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Teuteberg
mesh_terms: D000704:Analysis of Variance; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods; D006353:Heart-Assist Devices; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D051437:Renal Insufficiency / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D003404:Creatinine