Objectives To access the prevalence and risk factors responsible for renal dysfunction after heart transplantation (HT) in Chinese single centre.
Methods We studied 248 consecutive adult patients who had undergone HT between June 2004 and May 2012 and who survived for at least 6 months. The abbreviated version of the Modification of Diet in Renal Disease Study (MDRD) equation was used to calculate glomerular filtration rate (GFR). A GFR < 60 ml/min/1.73m2 was used to define renal dysfunction. Basiliximab as induction agent was administered to all patients. The triple immunosuppressive regimen consisted of cyclosporine A/tacrolimus, mycophenolate mofetil/azathioprine and predisone. Reduced-dose calcineurin inhibitor plus sicrolimus were administered to patients with renal dysfunction after HT. Univariate analysis and logistic regression analysis were used to determine preoperative and postoperative factors responsible for renal dysfunction after HT.
Results The median follow-up was 37 months (20-57 months). Renal dysfunction was present in 18.5% of patients before HT and in 27.0% at some time after HT. Serum creatinine >2.5 mg/dl was detected during follow-up in 2 (0.8%) patients. New-onset renal dysfunction was present in 17.7% of patients postoperatively and sirolimus utilisation rate was 22.6%. Univariate analysis identified that the presence of post-HT renal dysfunction correlated with patient age, BMI, pre-existing ischaemic heart disease, history of pre-HT hypertension, preoperative renal dysfunction, renal dysfunction at 1 month after HT and cyclosporine A rather than tacrolimus based immunosuppressive therapy. Logistic regression analysis confirmed patient age ([OR]: 1.07, 95% CI: 1.03-1.11, P = 0.001) pre-HT renal dysfunction ([OR]: 2.78, 95% CI: 1.26-6.12, P = 0.011), and renal dysfunctionat 1 month after HT ([OR]: 3.88, 95% CI: 1.33-11.36, P = 0.013) as significant predictors of the development of post-HT renal dysfunction.
Conclusions Renal dysfunction was a common complication after HT. Patient age, pre-HT renal dysfunction and renal dysfunction at 1 month after HT were independent predictors of the presence of post-HT renal dysfunction.