Cc. Canver et al., Acute renal failure requiring hemodialysis immediately after heart transplantation portends a poor outcome, J CARD SURG, 41(2), 2000, pp. 203-206
Background. Previous studies have not provided a definite clarification for
the predictive value of pretransplant renal indices on postcardiac transpl
ant patient outcome. Therefore, the purpose of this study was to investigat
e the interaction between pretransplant renal function and recovery after h
eart transplantation.
Methods. The study group consisted of 199 consecutive patients who underwen
t heart transplantation between 1973 and 1994. For better comparison, patie
nts were arbitrarily divided into three different groups based on the year
of the transplant operation: Group I - before 1985 (n = 13), Group II - bet
ween 1985 and 1989 (n = 68) and Group III - between 1990 and 1994 (n = 118)
. Values for serum creatinine (Cr), blood urea nitrogen (BUN), urea/creatin
ine ratio (U/Cr), creatinine clearance (Cr-cl), length of hospital stay (LO
S), early (30-day) mortality, and survival at 1-year and at 5-year were col
lected for each patient. The data was analyzed by the use of univariate log
-rank test with forward stepwise procedure.
Results. Postcardiac transplant LOS in the hospital or survival was unaffec
ted by the pretransplant renal indices except the U/Cr ratio (p>0.05). When
adjusted for the time, the U/Cr ratio was also insignificant (p = 0.1349).
The use of hemodialysis was necessary ill 9 Patients (4.5%) for treatment
of acute renal failure manifested immediately after the transplant operatio
n. Early mortality was 44% for these 9 cardiac transplant recipients who re
quired the use of hemodialysis: 0% (0/3) in the 1985-1989 period and 67% (4
/6) in the 1990-1994 period.
Conclusions. Pretransplant renal indices have no predictive value on outcom
e after a heart transplant operation, however, postcardiac transplant acute
renal failure necessitating hemodialysis portends a poor outcome.