Impact of perioperative renal dysfunction in heart transplantation: Combined heart and kidney transplantation could help to reduce postoperative mortality

Abstract

Renal dysfunction is a frequent problem in heart failure patients. We aimed to investigate the predictors of mortality after heart transplantation and the impact of perioperative renal dysfunction on short-term and long-term prognosis. We analyzed the outcomes of patients undergoing isolated heart transplantation (IHT, n=62) and combined heart-kidney transplantation (CHKT, n=5) between October 2007 and May 2012. Among all patients, 55.2% had preoperative renal dysfunction. Compared with the IHT group, the CHKT group had a lower estimated glomerular filtration rate (p=0.001), and higher proportion of diabetes (p=0.008), hypertension (p=0.010), renal failure (p=0.036), and greater incidence of preoperative continuous renal replacement therapy (CRRT) (p=0.025). Despite unfavorable baseline conditions in the CHKT group, there was no postoperative mortality. Early 30-day postoperative mortality only occurred in the IHT group (5 patients, 8.1%). In multivariate analysis, persistent renal dysfunction (HR 29.356, p<0.001), donor heart ischemic time (HR 1.014, p=0.005), and duration of mechanical ventilation (HR 1.012, p=0.026) were significant predictors of overall mortality. The patients with persistent renal dysfunction at 1 month after transplantation showed significantly lower survival rates compared to the patients with complete renal recovery (10% vs. 93% at 1 year, p<0.001). In the long-term follow-up of patients who had preoperative renal dysfunction, IHT showed only 64% survival, whereas CHKT showed 100%. Renal dysfunction was a common manifestation in heart transplantation recipients. Persistent renal dysfunction after transplantation was the most powerful independent predictor of overall mortality. CHKT could help to reduce postoperative mortality in end-stage heart failure patients with renal dysfunction.