title: Renal function at 1 year after cardiac transplantation rather than acute kidney injury is highly associated with long-term patient survival and loss of renal function - a retrospective cohort study.
abstract: This study aimed to assess the association between acute kidney injury (AKI), renal function 1 year after transplantation, and long-term adverse outcomes after cardiac transplantation. A retrospective cohort study was performed including 471 adult cardiac transplantation recipients that survived the first postoperative year between 1984 and 2012. Primary outcome variables were long-term overall and renal survival. During the first postoperative week, 40% (n = 188) of the recipients developed AKI stage I, 22% (n = 104) stage II, and 13% (n = 63) stage III, and 4% (n = 17) required temporary renal replacement therapy (RRT). No crude association was found between the development of AKI and long-term mortality (P = 0.50) or chronic RRT dependence (P = 0.27). In multivariable analysis, only AKI requiring RRT was associated with an increased risk for mortality (HR = 2.59, 95% CI = 1.17-5.73) and chronic RRT dependence (HR = 13.14, 95% CI = 3.26-52.92). While less severe episodes of AKI did not affect the recipient's long-term prognosis, renal function 1 year after transplantation had a strong association with long-term outcome. An eGFR <30 ml/min/1.73 was independently associated with mortality (HR = 2.69, 95% CI = 1.68-4.32) and an eGFR <60 ml/min/1.73 with chronic RRT dependence (eGFR 30-59: HR = 3.57, 95% CI = 1.41-9.01; eGFR <30: HR = 16.53, 95% CI = 5.72-47.78). In conslusion, besides AKI requiring RRT, less severe episodes of AKI have limited implications for the recipient's prognosis and long-term outcome after cardiac transplantation is strongly determined by the degree of renal impairment 1 year after transplantation.
authors.affiliation: Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Gijs
authors.identifier: http://orcid.org/0000-0002-9077-8654
authors.initials: G
authors.lastname: Fortrie
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Olivier C
authors.initials: OC
authors.lastname: Manintveld
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Alina A
authors.initials: AA
authors.lastname: Constantinescu
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: van de Woestijne
authors.affiliation: Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Michiel G H
authors.initials: MGH
authors.lastname: Betjes
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: acute renal failure; chronic kidney disease; end-stage renal disease; epidemiology; heart transplantation; survival analysis