Outcomes after heart transplantation in patients with and without pretransplant renal dysfunction

Objective. To compare long-term survival and incidence of ESRD between patients with and without preoperative renal dysfunction following heart transplantation. Design. Fifty consecutive patients with preoperative estimated GFR <= than 50 ml/min were compared with 50 age-matched patients with estimated GFR >= than 80 ml/min who underwent heart transplantation between 1994 and 1998. We investigated two primary outcomes: death and development of ESRD. We also analyzed risk factors. Results. Eight patients (16%) developed ESRD and 19 (38%) died in the control group whereas 10 patients (20%) developed ESRD and 26 (52%) died in the renal failure group during a mean follow-up period of 6.74 +/- 3.31 years. Survival and time to ESRD were not significantly different. In univariate and multivariate analysis, waiting time was the only risk factor found to predict mortality but not ESRD. High cyclosporine levels were only found to be associated with lower estimated GFR (p < 0.009). Among the control group, mortality was significantly higher in the subgroup of patients that developed >= 50% reduction of estimated GFR at the end of the first post transplant year (p < 0.05). Conclusions. This study suggests that low pre-transplant estimated GFR may not accurately predict long-term development of ESRD.