BACKGROUND: Risk factors for the development of chronic renal insufficiency after solid-organ transplantation remain unclear. METHODS: We conducted a 5-year retrospective analysis of all adult patients (n = 160) who survived >1 year after orthotopic heart transplantation at our institution from 1985 through 1992. Study subjects were classified into 3 groups based on peri-operative renal function: (1) pre-operative creatinine concentration <1.5 mg/dl and a post-operative (first 4 days) creatinine <2.0 mg/dl (n = 75); (2) pre-operative creatinine of <1.5 mg/dl but a post-operative creatinine of >2.0 mg/dl (n = 47); (3) pre-operative creatinine of >1.5 mg/dl (n = 38). The association between development of chronic renal insufficiency and peri-operative renal dysfunction was evaluated using the Cox proportional hazard model. RESULTS: A total of 47 (29.4%) patients experienced chronic renal insufficiency (serial serum creatinine >2.0 mg/dl on 2 or more monthly examinations). The mean pre-operative serum creatinine was 1.6 mg/dl in patients who experienced chronic renal insufficiency, whereas it was 1.3 mg/dl in patients who did not (p < 0.01). The fraction of patients in whom chronic renal insufficiency developed was highest in Group 3 (55.3%), lower in Group 2 (25.5%), and lowest in Group 1 (18.7%) (p < 0.01). After adjusting for multiple potential confounding variables, including cyclosporine dosage, the risk of chronic renal insufficiency linearly decreased in the 3 groups, stratified by peri-operative renal function (relative risk, 1.82; 95% confidence interval, 1.23-2.7). However, the difference in relative risk of renal insufficiency was not statistically significant between Group 2 and Group 1. CONCLUSION: Pre-operative serum creatinine concentration predicts development of renal insufficiency after heart transplantation.
BACKGROUND: Risk factors for the development of chronic renal insufficiency after solid-organ transplantation remain unclear. METHODS: We conducted a 5-year retrospective analysis of all adult patients (n = 160) who survived >1 year after orthotopic heart transplantation at our institution from 1985 through 1992. Study subjects were classified into 3 groups based on peri-operative renal function: (1) pre-operative creatinine concentration <1.5 mg/dl and a post-operative (first 4 days) creatinine <2.0 mg/dl (n = 75); (2) pre-operative creatinine of <1.5 mg/dl but a post-operative creatinine of >2.0 mg/dl (n = 47); (3) pre-operative creatinine of >1.5 mg/dl (n = 38). The association between development of chronic renal insufficiency and peri-operative renal dysfunction was evaluated using the Cox proportional hazard model. RESULTS: A total of 47 (29.4%) patients experienced chronic renal insufficiency (serial serum creatinine >2.0 mg/dl on 2 or more monthly examinations). The mean pre-operative serum creatinine was 1.6 mg/dl in patients who experienced chronic renal insufficiency, whereas it was 1.3 mg/dl in patients who did not (p < 0.01). The fraction of patients in whom chronic renal insufficiency developed was highest in Group 3 (55.3%), lower in Group 2 (25.5%), and lowest in Group 1 (18.7%) (p < 0.01). After adjusting for multiple potential confounding variables, including cyclosporine dosage, the risk of chronic renal insufficiency linearly decreased in the 3 groups, stratified by peri-operative renal function (relative risk, 1.82; 95% confidence interval, 1.23-2.7). However, the difference in relative risk of renal insufficiency was not statistically significant between Group 2 and Group 1. CONCLUSION: Pre-operative serum creatinine concentration predicts development of renal insufficiency after heart transplantation.
Authors: Jill Savla; Kimberly Y Lin; Madhura Pradhan; Rebecca L Ruebner; Rachel S Rogers; Somaly S Haskins; Anjali T Owens; Peter Abt; J William Gaynor; Robert E Shaddy; Joseph W Rossano Journal: J Am Heart Assoc Date: 2015-12-11 Impact factor: 5.501
Authors: Hrvoje Gašparović; Lucija Svetina; Filip Lončarić; Jana Ljubas; Maja Čikeš; Bojan Biočina; Davor Miličić Journal: Croat Med J Date: 2018-10-31 Impact factor: 1.351