Cargando…
Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation
End stage renal disease (ESRD) is a contraindication to isolated heart transplantation (HT). However, heart candidates with cardiogenic shock may experience acute kidney injury and require renal replacement therapy (RRT) and isolated HT as a life-saving operation. The outcomes, including survival an...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977403/ https://www.ncbi.nlm.nih.gov/pubmed/35387394 http://dx.doi.org/10.3389/ti.2022.10185 |
_version_ | 1784680755741327360 |
---|---|
author | Chen, Jeng-Wei Chou, Nai-Kuan Wang, Chih-Hsien Chi, Nai-Hsin Huang, Shu-Chien Yu, Hsi-Yu Chen, Yih-Sharng Hsu, Ron-Bin |
author_facet | Chen, Jeng-Wei Chou, Nai-Kuan Wang, Chih-Hsien Chi, Nai-Hsin Huang, Shu-Chien Yu, Hsi-Yu Chen, Yih-Sharng Hsu, Ron-Bin |
author_sort | Chen, Jeng-Wei |
collection | PubMed |
description | End stage renal disease (ESRD) is a contraindication to isolated heart transplantation (HT). However, heart candidates with cardiogenic shock may experience acute kidney injury and require renal replacement therapy (RRT) and isolated HT as a life-saving operation. The outcomes, including survival and renal function, are rarely reported. We enrolled 569 patients undergoing isolated HT from 1989 to 2018. Among them, 66 patients required RRT before HT (34 transient and 32 persistent). The survival was worse in patients with RRT than those without (65.2% vs 84.7%; 27.3% vs 51.1% at 1- and 10-year, p < 0.001 and p = 0.012, respectively). Multivariate Cox analysis identified pre-transplant hyperbilirubinemia (Hazard ratio (HR) 2.534, 95% confidence interval (CI) 1.098–5.853, p = 0.029), post-transplant RRT (HR 5.551, 95%CI 1.280–24.068, p = 0.022) and post-transplant early bloodstream infection (HR 3.014, 95%CI 1.270–7.152, p = 0.012) as independent risk factors of 1-year mortality. The majority of operative survivors (98%) displayed renal recovery after HT. Although patients with persistent or transient RRT before HT had a similar long-term survival, patients with persistent RRT developed a high incidence (49.2%) of dialysis-dependent ESRD at 10 years. In transplant candidates with pretransplant RRT, hyperbilirubinemia should be carefully re-evaluated for the eligibility of HT whereas prevention and management of bloodstream infection after HT improve survival. |
format | Online Article Text |
id | pubmed-8977403 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-89774032022-04-05 Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation Chen, Jeng-Wei Chou, Nai-Kuan Wang, Chih-Hsien Chi, Nai-Hsin Huang, Shu-Chien Yu, Hsi-Yu Chen, Yih-Sharng Hsu, Ron-Bin Transpl Int Health Archive End stage renal disease (ESRD) is a contraindication to isolated heart transplantation (HT). However, heart candidates with cardiogenic shock may experience acute kidney injury and require renal replacement therapy (RRT) and isolated HT as a life-saving operation. The outcomes, including survival and renal function, are rarely reported. We enrolled 569 patients undergoing isolated HT from 1989 to 2018. Among them, 66 patients required RRT before HT (34 transient and 32 persistent). The survival was worse in patients with RRT than those without (65.2% vs 84.7%; 27.3% vs 51.1% at 1- and 10-year, p < 0.001 and p = 0.012, respectively). Multivariate Cox analysis identified pre-transplant hyperbilirubinemia (Hazard ratio (HR) 2.534, 95% confidence interval (CI) 1.098–5.853, p = 0.029), post-transplant RRT (HR 5.551, 95%CI 1.280–24.068, p = 0.022) and post-transplant early bloodstream infection (HR 3.014, 95%CI 1.270–7.152, p = 0.012) as independent risk factors of 1-year mortality. The majority of operative survivors (98%) displayed renal recovery after HT. Although patients with persistent or transient RRT before HT had a similar long-term survival, patients with persistent RRT developed a high incidence (49.2%) of dialysis-dependent ESRD at 10 years. In transplant candidates with pretransplant RRT, hyperbilirubinemia should be carefully re-evaluated for the eligibility of HT whereas prevention and management of bloodstream infection after HT improve survival. Frontiers Media S.A. 2022-03-21 /pmc/articles/PMC8977403/ /pubmed/35387394 http://dx.doi.org/10.3389/ti.2022.10185 Text en Copyright © 2022 Chen, Chou, Wang, Chi, Huang, Yu, Chen and Hsu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Health Archive Chen, Jeng-Wei Chou, Nai-Kuan Wang, Chih-Hsien Chi, Nai-Hsin Huang, Shu-Chien Yu, Hsi-Yu Chen, Yih-Sharng Hsu, Ron-Bin Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation |
title | Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation |
title_full | Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation |
title_fullStr | Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation |
title_full_unstemmed | Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation |
title_short | Impact of Pretransplant Renal Replacement Therapy on Clinical Outcome After Isolated Heart Transplantation |
title_sort | impact of pretransplant renal replacement therapy on clinical outcome after isolated heart transplantation |
topic | Health Archive |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977403/ https://www.ncbi.nlm.nih.gov/pubmed/35387394 http://dx.doi.org/10.3389/ti.2022.10185 |
work_keys_str_mv | AT chenjengwei impactofpretransplantrenalreplacementtherapyonclinicaloutcomeafterisolatedhearttransplantation AT chounaikuan impactofpretransplantrenalreplacementtherapyonclinicaloutcomeafterisolatedhearttransplantation AT wangchihhsien impactofpretransplantrenalreplacementtherapyonclinicaloutcomeafterisolatedhearttransplantation AT chinaihsin impactofpretransplantrenalreplacementtherapyonclinicaloutcomeafterisolatedhearttransplantation AT huangshuchien impactofpretransplantrenalreplacementtherapyonclinicaloutcomeafterisolatedhearttransplantation AT yuhsiyu impactofpretransplantrenalreplacementtherapyonclinicaloutcomeafterisolatedhearttransplantation AT chenyihsharng impactofpretransplantrenalreplacementtherapyonclinicaloutcomeafterisolatedhearttransplantation AT hsuronbin impactofpretransplantrenalreplacementtherapyonclinicaloutcomeafterisolatedhearttransplantation |