The Influence Factors Of Patients With Renal Insufficiency After Heart Transplantation

Objective:To investigate the renal function changes in patients at1month and1year after heart transplantation. Methods:A total of81patients with heart transplantation were monitored for their renal function by99mTc-DTPA renal dynamic imaging at1month and1year after the operation. Renal dysfunction (RD) was defined as glomerular filtration rate (GFR)<60ml/min. The patients were divided into RD(n=25) before transplantation group and Non-RD(n=56) before transplantation group. We compared the renal function in both groups and studied the effect of immunosuppressive drugs cyclosporine and tacrolimus in all patients.Results:The incidences of RD were30.9%,43.2%and60.5%at pre-transplantation,1month and1year after transplantation, and severe RD was6.2%at1year after transplantation. The average CFR was lower at1year after the operation than it was before,(56.72±19.08) vs.(70.81±20.80)ml/min, P<0.01, whi le the serum creatinine level was similar,P>0.05. In RD before transplantation group,CFR elevated at1month after the operation than it was before,(56.08±17.62) vs.(47.71±9.98) ml/min, P<0.05. In Non-RD before transplantation group, CFR decreased at1month and1year after the operation than they were before,(68.80±18.39) and (59.71±19.17) vs.(81.21±15.27) ml/min, P<0.01. The patients using post-operative cyclosporine had higher incidence of RD at1year after the operation than they were before as68.2%vs.28.3%, P<0.01, no such difference in patients using tacrolimus.The rejection over class Ⅱ was similar for both drugs.Conclusion:CFR is decreased at1year after heart transplantation, serum creatinine remains similar.99mTc-DTPA renal dynamic imaging is good for evaluating renal function. Tacrolimus is superior to cyclosporine for keeping long term renal function. Objective:To investigate the factors of acute renal failure(ARF) after early heart transplantation.Methods:We performed a retrospective cohort study of214patients who received a heart transplant between June2004and February2011.we defined ARF as≥26.4umol/L or≥50%increase in serum creatinine from pre-operatively to the seventh day post-HTx and/or the need of early post-operative dialysis.The patients were divided into ARF group(n=51) and Non-ARF group(n=163). The preoperative factors which may caused ARF after heart transplantation were analyzed by univariate analysis and multifactorial regression analysis, then we compared the difference in creatinine and mortality of the two groups at1year after HTx.Results:Of all patients,51(23.8%)developed ARF, and21(9.8%)patients required early post-operative dialysis.Univariate analysis demonstrated the following variables to be associated with ARF:(previous history of cardiac surgery and blood transfusion),[application extracorporeal membrane oxygenation(ECMO) of peri operative, CPB time, mechanical ventilation time, transfusion red blood cells of intraoperative and postoperative], and (CO, CVP, the TNI of early postoperative, systolic blood pressure ratio at the the third day of postoperative);The application of Cyclospine was significantly postponed the group of ARF(3.33±1.27d) than the group of Non-ARF(2.85±1.17d). Independent risk factors by the logistic regression analysis were previous history of blood transfusion(odds ratio [OR]11.84,95%CI2.48-56.56, P=0.002), application ECMO of perioperative (OR6.72,95%CI1.23-36.63, P=0.028), mechanical ventilation time>30h (OR1.98,95%CI1.05-3.74, P=0.035), transfusion red blood cells of intraoperative and postoperative>20U(OR4.54,95%CI1.62-12.69, P=0.004) and the TNI of early postoperative>50ng/ml (OR4.50,95%CI1.78-11.34, P=0.001);The separately mortality of the ARF group and the Non-ARF group were7.8%(4/51) and1.2%(2/163) at perioperative, the result of survival analysis(log-rank test) was P=0.019; No significant difference in creatinine of the two groups1year after HTx.Conclusion:Acute renal failure is one of the important complications after HTx, which can increase perioperative mortality,the factors were associated with the preoperative, intraoperative and postoperative. Previous history of blood transfusion, application ECMO of perioperative, mechanical ventilation time>30h, transfusion red blood cells of intraoperative and postoperative>20U and the TNI of early postoperative>50ng/ml were independent risk factors of ARF;The application of Basiliximab by use time can postpone the use of cyclosporine without increasing the occurrence of rejection, that contributed to maintain renal function.