(143) - Donor- and Recipient-Related Predictors of Mortality After Heart Transplantation: Results From a Contemporary French National Cohort

Abstract

s S61 Methods: 117 patients undergoing HTx at IKEM were prospectively enrolled. AKI was defined as an increase of serum creatinine level by ≥ 50% or worsening of renal function requiring renal replacement therapy (RRT) during 1st week postHTx. Serum Cystatin-C and urinary Neutrophil gelatinase-associated lipocalin (NGAL), alpha-1-microglobulin (A1M) or albumin were serially sampled. Results: 30 patients (25.6% of total) fulfilled the criteria of AKI. Preoperative renal function, demographics and comorbidities were similar between AKI and non-AKI groups. Cystatin-C displayed earliest and the most robust separation between AKI and non-AKI group, with significant difference present already 3 hours after surgery (figure left, arrow) and persisting on day 7 and 10. The increase in Cystatin-C preceded the serum creatinine elevation by 4 days. In univariate analysis, Cystatin-C> 1.6 mg/L at 3-hours after HTx predicted AKI with OR 5.1 (95%CI: 2.2-13) and in multivariate analysis (adjustment to presence of sepsis, bleeding or need of RVAD) with OR 4.4 (95% CI:1.7-12). Urinary NGAL raised significantly only on day 3 in AKI group (p= 0.003). Differences in ACR and A1M values between groups did not reach significance. Interestingly, elevated Cystatin-C (≥ 2.5mg/L at day 7) predicted also long-term mortality after HTx (figure right). Conclusion: Cystatin-C was the most useful for evaluation and prediction of AKI. Measurement of serum Cystatin-C in patients early after HTx (3h after surgery) may help to promptly identify the patients with high risk for renal complications. Elevated cystatin-C also predicts long-term outcome. (Grant NT/11269 5 and NT/ 11262-6 and Institutional support 00023001) ascending aortic diameter was also a predictor and may reflect the risks associated with an undersized allograft. The final predictor was total ischemic time emphasizing the need for improvements in allograft preservation and storage.