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The Clinical Impact of an Early Decline in Kidney Function in Patients Following Heart Transplantation

  1. M. Cantarovich1,*,
  2. A. Hirsh1,
  3. A. Alam1,
  4. N. Giannetti1,
  5. R. Cecere2,
  6. P. Carroll1,
  7. M. E. Edwardes3

Article first published online: 15 DEC 2008

DOI: 10.1111/j.1600-6143.2008.02490.x

Issue

American Journal of Transplantation

American Journal of Transplantation

Volume 9, Issue 2, pages 348–354, February 2009

Additional Information

How to Cite

Cantarovich, M., Hirsh, A., Alam, A., Giannetti, N., Cecere, R., Carroll, P. and Edwardes, M. E. (2009), The Clinical Impact of an Early Decline in Kidney Function in Patients Following Heart Transplantation. American Journal of Transplantation, 9: 348–354. doi: 10.1111/j.1600-6143.2008.02490.x

Author Information

  1. 1

    Multi-Organ Transplant Program, Department of Medicine

  2. 2

    Division of Cardiovascular and Thoracic Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada

  3. 3

    Everest Clinical Research Services, Markham, Ontario, Canada

* * Corresponding author: Marcelo Cantarovich, marcelo.cantarovich@muhc.mcgill.ca

Publication History

  1. Issue published online: 27 JAN 2009
  2. Article first published online: 15 DEC 2008
  3. Received 26 May 2008, revised 20 September 2008 and accepted for publication 30 September 2008

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Keywords:

  • Chronic dialysis;
  • creatinine clearance;
  • heart transplantation;
  • kidney transplantation;
  • mortality;
  • survival

A decline in the creatinine clearance during the first year predicts advanced chronic kidney disease, chronic dialysis and death in heart transplant recipients.

Renal dysfunction is a well-known complication following heart transplantation. We examined an early decline in kidney function as a predictor of progression to end-stage renal disease and mortality in heart transplant recipients. We performed a retrospective cohort study of 233 patients who received a heart transplant between July 1985 and July 2004, and who survived >1 month. The decline in estimated creatinine clearance (CrCl) was used to predict the outcomes of need for chronic dialysis or mortality >1-year posttransplant. The earliest time to chronic dialysis was 484 days. A 30% decline in CrCl between 1 month and 12 months predicted the need for chronic dialysis (p = 0.01), all-cause mortality (p < 0.0001) and time to first CrCl ≤30 mL/min at >1-year posttransplant (p = 0.02). A 30% decline in CrCl between 1 month and 3 months also independently predicted the need for chronic dialysis (p = 0.04) and time to first CrCl ≤ 30 mL/min at >1-year posttransplant (p = 0.01). In conclusion, an early drop in CrCl within the first year is a strong predictor of chronic dialysis and death >1-year postheart transplantation. Future studies should focus on kidney function preservation in those identified at high risk for progression to end-stage kidney disease and mortality.

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