title: The Impact of Donor and Recipient Renal Dysfunction on Cardiac Allograft Survival: Insights Into Reno-Cardiac Interactions.
abstract: BACKGROUND
  Renal dysfunction (RD) is a potent risk factor for death in patients with cardiovascular disease. This relationship may be causal; experimentally induced RD produces findings such as myocardial necrosis and apoptosis in animals. Cardiac transplantation provides an opportunity to investigate this hypothesis in humans.
  
  
  RESULTS
  Cardiac transplantations from the United Network for Organ Sharing registry were studied (n = 23,056). RD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2). RD was present in 17.9% of donors and 39.4% of recipients. Unlike multiple donor characteristics, such as older age, hypertension, or diabetes, donor RD was not associated with recipient death or retransplantation (age-adjusted hazard ratio [HR] = 1.00, 95% confidence interval [CI] 0.94-1.07, P = .92). Moreover, in recipients with RD the highest risk for death or retransplantation occurred immediately posttransplant (0-30 day HR = 1.8, 95% CI 1.54-2.02, P < .001) with subsequent attenuation of the risk over time (30-365 day HR = 0.92, 95% CI 0.77-1.09, P = .33).
  
  
  CONCLUSIONS
  The risk for adverse recipient outcomes associated with RD does not appear to be transferrable from donor to recipient via the cardiac allograft, and the risk associated with recipient RD is greatest immediately following transplant. These observations suggest that the risk for adverse outcomes associated with RD is likely primarily driven by nonmyocardial factors.
authors.affiliation: Department of Internal Medicine and the Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, United States.
authors.forename: Olga
authors.initials: O
authors.lastname: Laur
authors.affiliation: Department of Medicine, Cardiology Division, Medical University of South Carolina, Charleston, South Carolina, United States.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Brisco
authors.affiliation: Department of Internal Medicine and the Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, United States.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Kula
authors.affiliation: Department of Internal Medicine and the Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, United States.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Cheng
authors.affiliation: Department of Internal Medicine and the Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, United States.
authors.forename: Abeel A
authors.initials: AA
authors.lastname: Mangi
authors.affiliation: Department of Internal Medicine and the Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, United States.
authors.forename: Lavanya
authors.initials: L
authors.lastname: Bellumkonda
authors.affiliation: Department of Internal Medicine and the Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, United States.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Jacoby
authors.affiliation: Department of Internal Medicine and the Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, United States.
authors.forename: Steven
authors.initials: S
authors.lastname: Coca
authors.affiliation: Department of Medicine, Cardiovascular Division, Cleveland Clinic Foundation, Cleveland, Ohio, United States.
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.affiliation: Department of Internal Medicine and the Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, United States.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.affiliation: Department of Internal Medicine and the Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, United States. Electronic address: jeffrey.testani@yale.edu.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Testani
mesh_terms: D000328:Adult; D064591:Allografts / Q000503:physiopathology*; D006085:Graft Survival; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications / Q000503:physiopathology*; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors; D055815:Young Adult
keywords: Reno-cardiac syndrome; cardiac transplantation; cardio-renal syndrome; renal dysfunction