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Jeon J, Park H, Kim Y, Kang D, Lee JE, Huh W, Guallar E, Cho J, Jang HR. Prognostic Factors of Renal Outcomes after Heart Transplantation: A Nationwide Retrospective Study. J Clin Med 2021; 10:jcm10215110. [PMID: 34768634 PMCID: PMC8584983 DOI: 10.3390/jcm10215110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Renal dysfunction after heart transplantation (HT) is associated with poor survival. We investigated the predictive factors of renal outcomes after HT using nationwide cohort data. In this retrospective cohort study using the Health Insurance Review and Assessment database of Korea, 654 patients who received HT between 2008 and 2016 and survived until discharge after HT were analyzed. The median (interquartile range) age was 52 (40-60) years, and 68.1% were male. Perioperative renal replacement therapy (RRT) was performed in 27.8% of patients. During 2.8 years of median followup, end-stage kidney disease (ESKD) developed in 12 patients (1.8%). In a fully adjusted model, RRT > 3 weeks, the use of inotropes/vasopressors and non-use of ACEi/ARB were associated with ESKD. Preexisting renal disease tended to be associated with ESKD. Among the 561 patients without preexisting CKD, 104 (18.5%) developed chronic kidney disease (CKD). Age, extracorporeal membrane oxygenation, and RRT were associated with the development of CKD after HT. Our nationwide cohort study demonstrated that perioperative RRT was a predictor of poor renal outcomes after HT. These results suggest that an active renoprotective strategy is required during the perioperative period.
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Affiliation(s)
- Junseok Jeon
- Division of Nephrology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.E.L.); (W.H.)
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.P.); (Y.K.); (D.K.); (E.G.)
| | - Youngha Kim
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.P.); (Y.K.); (D.K.); (E.G.)
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.P.); (Y.K.); (D.K.); (E.G.)
| | - Jung Eun Lee
- Division of Nephrology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.E.L.); (W.H.)
| | - Wooseong Huh
- Division of Nephrology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.E.L.); (W.H.)
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.P.); (Y.K.); (D.K.); (E.G.)
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.P.); (Y.K.); (D.K.); (E.G.)
- Correspondence: (J.C.); (H.R.J.); Tel.: +82-2-3410-6639 (J.C.); +82-2-3410-0782 (H.R.J.)
| | - Hye Ryoun Jang
- Division of Nephrology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.E.L.); (W.H.)
- Correspondence: (J.C.); (H.R.J.); Tel.: +82-2-3410-6639 (J.C.); +82-2-3410-0782 (H.R.J.)
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Taiwo AA, Khush KK, Stedman MR, Zheng Y, Tan JC. Longitudinal changes in kidney function following heart transplantation: Stanford experience. Clin Transplant 2018; 32:e13414. [PMID: 30240515 PMCID: PMC6265058 DOI: 10.1111/ctr.13414] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/08/2018] [Accepted: 09/13/2018] [Indexed: 11/30/2022]
Abstract
Many heart transplant recipients experience declining kidney function following transplantation. We aimed to quantify change in kidney function in heart transplant recipients stratified by pre-transplant kidney function. A total of 230 adult heart transplant recipients between May 1, 2008, and December 31, 2014, were evaluated for up to 5 years post-transplant (median 1 year). Using 19 398 total estimated glomerular filtration rate (eGFR) assessments, we evaluated trends in eGFR in recipients with normal/near-normal (eGFR ≥45 mL/min/1.73 m2 ) vs impaired (eGFR <45 mL/min/1.73 m2 ) kidney function and the likelihood of reaching an eGFR of 20 mL/min/1.73 m2 after heart transplant. Baseline characteristics were similar. Immediately following heart transplant, the impaired pre-transplant kidney function group showed a mean eGFR gain of 9.5 mL/min/1.73 m2 (n = 193) vs a mean decline of 4.9 mL/min/1.73 m2 (n = 37) in the normal/near-normal group. Subsequent rates of eGFR decline were 2.2 mL/min/1.73 m2 /y vs 2.9 mL/min/1.73 m2 /y, respectively. The probability of reaching an eGFR of 20 mL/min/1.73 m2 or less at 1, 5, and 10 years following heart transplant was 1%, 4%, and 30% in the impaired group, and <1%, <1%, and 10% in the normal/near-normal group. Estimates of expected recovery in kidney function and its decline over time will help inform decision making about kidney care after heart transplantation.
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Affiliation(s)
- Adetokunbo A Taiwo
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford Hospital & Clinics, Palo Alto, California
| | - Margaret R Stedman
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
| | - Yuanchao Zheng
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
| | - Jane C Tan
- Division of Nephrology, Stanford Hospital & Clinics, Palo Alto, California
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