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- Title
Renal function at 1 year after cardiac transplantation rather than acute kidney injury is highly associated with long-term patient survival and loss of renal function - a retrospective cohort study.
- Authors
Fortrie, Gijs; Manintveld, Olivier C.; Constantinescu, Alina A.; Woestijne, Pieter C.; Betjes, Michiel G. H.
- Abstract
This study aimed to assess the association between acute kidney injury ( AKI), renal function 1 year after transplantation, and long-term adverse outcomes after cardiac transplantation. A retrospective cohort study was performed including 471 adult cardiac transplantation recipients that survived the first postoperative year between 1984 and 2012. Primary outcome variables were long-term overall and renal survival. During the first postoperative week, 40% ( n = 188) of the recipients developed AKI stage I, 22% ( n = 104) stage II, and 13% ( n = 63) stage III, and 4% ( n = 17) required temporary renal replacement therapy ( RRT). No crude association was found between the development of AKI and long-term mortality ( P = 0.50) or chronic RRT dependence ( P = 0.27). In multivariable analysis, only AKI requiring RRT was associated with an increased risk for mortality ( HR = 2.59, 95% CI = 1.17-5.73) and chronic RRT dependence ( HR = 13.14, 95% CI = 3.26-52.92). While less severe episodes of AKI did not affect the recipient's long-term prognosis, renal function 1 year after transplantation had a strong association with long-term outcome. An eGFR <30 ml/min/1.73 was independently associated with mortality ( HR = 2.69, 95% CI = 1.68-4.32) and an eGFR <60 ml/min/1.73 with chronic RRT dependence ( eGFR 30-59: HR = 3.57, 95% CI = 1.41-9.01; eGFR <30: HR = 16.53, 95% CI = 5.72-47.78). In conslusion, besides AKI requiring RRT, less severe episodes of AKI have limited implications for the recipient's prognosis and long-term outcome after cardiac transplantation is strongly determined by the degree of renal impairment 1 year after transplantation.
- Subjects
KIDNEY function tests; HEART transplantation; ACUTE kidney failure; SURVIVAL analysis (Biometry); RETROSPECTIVE studies; COHORT analysis
- Publication
Transplant International, 2017, Vol 30, Issue 8, p788
- ISSN
0934-0874
- Publication type
Article
- DOI
10.1111/tri.12940