Risk factors for chronic renal dysfunction in cardiac allograft recipients

Renal dysfunction is one of the most common and threatening complications i n heart transplant recipients. Even if ciclosporin seems to play a central role in inducing renal damage, other factors may concur or predispose to re nal injury. In order to identify factors responsible for renal dysfunction, we retrospectively studied a cohort of 114 cardiac transplant recipients d uring a follow-up period of at least 3 years. The patients had a normal ren al function before and 0.5 months after heart transplantation. Doubling of baseline serum creatinine or attainment of serum creatinine steadily above 176.8 mu mol/l (2.0 mg/dl) was used as criterion to define the end-point re nal dysfunction. A series of clinical and laboratory variables were obtaine d from the patients' charts at different time intervals, and their prognost ic value for the occurrence of renal dysfunction was calculated by Cox prop ortional hazards models. 23 out of 114 patients reached the end point after a median time period of 21 months. High serum triglyceride, alanine aminot ransferase, alkaline phosphatase, ciclosporin, urea, glucose, and hemoglobi n levels were shown to be associated with the development of renal dysfunct ion. Four variables, i.e., triglyceride, ciclosporin, urea, and alkaline ph osphatase, had an independent prognostic value. Our results confirm a role for ciclosporin in inducing renal dysfunction and identify hyperlipidemia a nd an increased plasma urea level as risk factors for renal dysfunction in heart transplant recipients. Copyright (C) 2000 S. Karger AG, Basel.