Predictors and evolution of renal function during 9 years following heart transplantation

Over a 9-yr period, heart transplantation was performed in 200 patients at Sahlgrenska University Hospital. Of these 200 patients, 151 were followed f or 1 to 9 yr with regard to renal function, hemodynamics, cyclosporin A con centrations, and complications. Patients with a preoperative serum creatini ne >130 mu mol/L received inotropic drugs to test for reversibility of rena l dysfunction. The end point was graft failure. The average preoperative GF R of 66 +/- 17 ml/min per 1.73 m(2) declined to 52 +/- 19, 44 +/- 16, and 3 7 +/- 17 at 1, 5, and 9 yr after heart transplantation, respectively. Altog ether, the average GFR declined by 44%. There was no significant correlatio n between the preoperative GFR and postoperative renal function or survival . Recipient age was a predictor of renal function during the entire follow- up. Severe renal dysfunction (GFR <20 ml/min per 1.73 m(2)) developed in 20 % of the patients, which was predicted by the recipient age at transplantat ion together with the GFR 1 yr after transplantation. A nomogram that shows the risk of developing severe renal dysfunction after heart transplantatio n is presented. Cyclosporin A concentrations and treatment with statins, ca lcium channel blockers, or angiotensin-converting enzyme inhibitors did not correlate with the evolution of renal function. Patients with a preoperati ve depressed renal function who improved on inotropic treatment seemed to h ave a poorer outcome compared with the other study patients.