Renal function and outcome after heart transplantation
Renal function and outcome after heart transplantation
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DOI：
10.1016/j.jtcvs.2017.11.087
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发表时间：
2018-04-01
影响因子：
6
通讯作者：
Dellgren, Goran
中科院分区：
文献类型：
--
作者：
Kolsrud, Oscar;Karason, Kristjan;Dellgren, Goran
目的：探讨测量的肾小球滤过率(MGFR)是否是心脏移植(HTX)后死亡和/或终末期肾病(ESRD)的危险因素。术前、术后均进行mGFR检查，作为年度随访。8例患者接受了同期肾移植(KTX)，15例患者因HTX后慢性肾功能衰竭而接受晚期KTX。结果：HTX后第一年，mGFR较术前平均下降12%。术前mGFR不能预测死亡率或终末期肾病。年龄较大或使用脑室辅助装置(VAD)是手术前死亡的预测因素。在移植后第一年，mGFR下降25%的患者的长期存活率明显较差。急性术后肾脏替代治疗(RRT)的需要与存活期受损有关，但不能预测存活者中的终末期肾病。在多变量分析中，既往心脏手术、术前VAD和较低的mGFR都是RRT的预测因素。在最近一段时间内，无终末期肾病的死亡率较低，多变量分析显示与终末期肾病相关的术前因素仅有机械通气和糖尿病。结论：在选定的患者群体中，移植前mGFR不能预测死亡率或终末期肾病，但需要同期或晚期的终末期肾移植。然而，移植后第一年血中-gt；25%mGFR下降的患者，以及术后早期依赖透析的急性肾功能不全患者，预后较差。我们建议，肾功能严重受损的患者，无论移植前的肾功能如何，仍然应该考虑进行HTX，但也鼓励对我们的结果进行仔细的解释，因为这一人群中存在选择偏见。
Objectives: To investigate whether measured glomerular filtration rate (mGFR) is a risk factor for death and/or end-stage renal disease (ESRD) after heart transplantation (HTx).Methods: All adult patients (n = 416) who underwent HTx between 1988 and 2010 were included. mGFR was performed both preoperatively and postoperatively as annual follow-up. Eight patients received a concomitant kidney transplant (KTx), and 15 underwent late KTx due to chronic renal failure after HTx.Results: The mean drop in mGFR compared with the preoperative value was 12% during the first year after HTx. Preoperative mGFR was not predictive of mortality or ESRD. Older or the use of a ventricular assist device (VAD) were preoperative predictors of death. Long-term survival was significantly worse in the patients who experienced a >25% decrease in mGFR during the first year after transplantation. The need for acute postoperative renal replacement therapy (RRT) was associated with impaired survival but did not predict ESRD among survivors. On multivariable analyses, previous heart surgery, preoperative VAD, and a lower mGFR were all predictors of RRT. In the most recent period, death without previous ESRD was lower, and the only preoperative factors associated with ESRD by multivariable analyses were mechanical ventilation and diabetes mellitus.Conclusions: Pretransplantation mGFR was not predictive of mortality or ESRD after HTx, but necessitated simultaneous or late-stage KTx in this selected population of patients. However, patients with a decrease in >25% mGFR during the first year post-transplantation, as well as early postoperative dialysis-dependent acute renal dysfunction, had a poor prognosis. We suggest that patients with severely impaired kidney function, irrespective of pretransplantation renal function, still should be considered for HTx, but also encourage careful interpretation of our results given the selection bias involved in this population.