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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2000 April;41(2):203-6

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Acute renal failure requiring hemodialysis immediately after heart transplantation portends a poor outcome

Canver C. C., Heisey D. M., Nichols R. D.

From the Division of Cardiothoracic Surgery Albany Medical College Albany, New York, USA


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Back­ground. Pre­vious ­studies ­have not pro­vided a def­i­nite clar­ifi­ca­tion for the pre­dic­tive ­value of pre­trans­plant ­renal ­indices on ­postcar­diac trans­plant ­patient out­come. There­fore, the pur­pose of ­this ­study was to inves­ti­gate the inter­ac­tion ­between pre­trans­plant ­renal func­tion and ­recovery ­after ­heart trans­plan­ta­tion.
­Methods. The ­study ­group con­sisted of 199 con­sec­u­tive ­patients who under­went ­heart trans­plan­ta­tion ­between 1973 and 1994. For ­better com­par­ison, ­patients ­were arbi­trarily ­divided ­into ­three dif­ferent ­groups ­based on the ­year of the trans­plant oper­a­tion: ­Group I - ­before 1985 (n=13), ­Group II - ­between 1985 and 1989 (n=68) and ­Group III - ­between 1990 and 1994 (n=118). ­Values for ­serum crea­ti­nine (Cr), ­blood ­urea ­nitrogen (BUN), ­urea/crea­ti­nine ­ratio (U/Cr), crea­ti­nine clear­ance (­Crcl), ­length of hos­pital ­stay (LOS), ­early (30-day) mor­tality, and sur­vival at 1-­year and at 5-­year ­were col­lected for ­each ­patient. The ­data was ana­lyzed by the use of uni­var­iate log-­rank ­test ­with for­ward step­wise pro­ce­dure.
­Results. ­Postcar­diac trans­plant LOS in the hos­pital or sur­vival was unaf­fected by the pre­trans­plant ­renal ­indices ­except the U/Cr ­ratio (p>0.05). ­When ­adjusted for the ­time, the U/Cr ­ratio was ­also insig­nif­i­cant (p=0.1349). The use of hemo­di­al­ysis was nec­es­sary in 9 ­patients (4.5%) for treat­ment of ­acute ­renal ­failure man­i­fested imme­di­ately ­after the trans­plant oper­a­tion. ­Early mor­tality was 44% for ­these 9 car­diac trans­plant recip­ients who ­required the use of hemo­di­al­ysis: 0% (0/3) in the 1985-1989 ­period and 67% (4/6) in the 1990-1994 ­period.
Con­clu­sions. Pre­trans­plant ­renal ­indices ­have no pre­dic­tive ­value on out­come ­after a ­heart trans­plant oper­a­tion, how­ever, ­postcar­diac trans­plant ­acute ­renal ­failure neces­si­tating hemo­di­al­ysis por­tends a ­poor out­come.

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