Acute renal failure requiring hemodialysis immediately after heart transplantation portends a poor outcome

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.