Abstract
Acute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term survival and risk factors of dialysis were investigated. Patients who had undergone dialysis were stratified to early or late dialysis for subgroup analysis. The mean follow-up was five years, the incidence of dialysis was 28.4% (21% early dialysis and 7.4% late dialysis). The dialysis cohort had higher overall mortality compared with the non-dialysis cohort. The hazard ratios of mortality in patients with dialysis were 3.44 (95% confidence interval (CI), 2.73–4.33) for all dialysis patients, 3.58 (95% CI, 2.74–4.67) for early dialysis patients, and 3.27 (95% CI, 2.44–4.36; all p < 0.001) for late dialysis patients. Patients with diabetes mellitus, chronic kidney disease, acute kidney injury, and coronary artery disease were at higher risk of renal failure requiring dialysis. Cardiomyopathy, hepatitis B virus infection, and hyperlipidemia treated with statins were associated with a lower risk of renal dysfunction requiring early dialysis. The use of Sirolimus and Mycophenolate mofetil was associated with a lower incidence of late dialysis. Renal dysfunction requiring dialysis after heart transplantation is common in Taiwan. Early and late dialysis were both associated with an increased risk of mortality in heart transplant recipients.
Highlights
Heart transplantation (HT) remains the gold standard treatment of advanced heart failure
The aims of this study were as follows: (1) determine the incidence of dialysis-requiring renal failure after HT; (2) assess if post-HT renal failure requiring dialysis is associated with a higher risk of long-term mortality; (3) characterize the risk factors related to renal failure requiring dialysis after HT; (4) examine crucial determinants associated with the need for early- and late-stage dialysis after HT
Significant differences were observed in HBV carrier status, cirrhosis, DM, chronic kidney disease (CKD), HTN, primary diagnosis for HT, and immunosuppressant usage between the dialysis and non-dialysis cohorts (p < 0.05)
Summary
Heart transplantation (HT) remains the gold standard treatment of advanced heart failure. The prognosis of HT has steadily improved with a recent median survival of 12.5 years among adult HT recipients [1]. Kidney disease after HT has become increasingly prevalent as outcomes following HT have improved [3]. Renal dysfunction in HT has a broad spectrum, including chronic kidney disease (CKD), end-stage renal disease (ESRD), and acute kidney injury (AKI). Schwarz et al [4] determined that the majority of biopsy-diagnosed renal disease after transplantation of other organs and tissues was related to hypertensive nephrosclerosis and chronic calcineurin inhibitor (CNI) toxicity. Extensive literature indicates that CKD [9,10] and ESRD [5,11] are independent risk factors for mortality in HT recipients
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