Prognostic value of glomerular filtration rate 1 year after heart transplantation

• Published in: Revista española de cardiologia Vol. 63; no. 5; pp. 564 - 570
• Main Authors: Navarro-Manchón, Josep, Martínez-Dolz, Luis, Almenar, Luis, Moro, José A, Zorio, Esther, Raso, Rafael, Buendía, Francisco, Sánchez-Lázaro, Ignacio, Agüero, Jaime, Salvador, Antonio
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01-05-2010
• Subjects: Adult; Aged; Female; Follow-Up Studies; Glomerular Filtration Rate - physiology; Graft Rejection - epidemiology; Heart Transplantation - adverse effects; Heart Transplantation - mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Predictive Value of Tests; Prognosis; Renal Insufficiency - diagnosis; Renal Insufficiency - etiology; Renal Insufficiency - mortality; Risk Assessment; Survival Analysis
• ISSN: 1579-2242
• DOI: 10.1016/S0300-8932(10)70118-4

The development of renal failure is one of the most important problems after heart transplantation (HT), but the wide range of definitions means that estimates of its prevalence vary considerably. Furthermore, its impact on mortality has not been adequately studied. The objective was to investigate the relationship between the glomerular filtration rate (GFR) 1 year after transplantation and mortality during follow-up.
The GFR was determined in 316 patients still living 1 year after transplantation using the abbreviated Modification of Diet in Renal Disease Study formula. Patients were divided into three groups according to GFR (i.e. <30, 30-59 and > or =60 mL/min per 1.73 m2) and pretransplant variables and rejection and infection rates within the first year were analyzed. The association between GFR at 1 year and mortality during follow-up was evaluated and reasons for the association were examined.
There was no difference in the number of rejections or infections in the first year between the three groups. During a mean follow-up period of 6.3 years, 74% of patients with a GFR <30 mL/min per 1.73 m2 died, compared with 24% and 30% of those with a GFR > or =60 and 30-59 mL/min per 1.73 m2, respectively. Survival analysis (i.e. Cox regression analysis) demonstrated a significant difference between patients with a GFR <30 mL/min per 1.73 m2 and other patients (P< .001). A very low GFR at 1 year was the only independent predictor that remained statistically significant on multivariate analysis (hazard ratio =2.87; 95% confidence interval, 1.52-5.41).
Severe renal dysfunction at 1 year was an independent predictor of long-term all-cause mortality in heart transplant patients.