The Prognostic Importance of Perioperative Renal Function and Outcome of Patients Undergoing Heart Transplantation

PURPOSE We aimed to investigate prognosis of heart transplanted (HTx) patients who experienced RRT in perioperative period. METHODS Korean Organ Transplant Registry (KOTRY) is nationwide, organ transplant registry in Korea. We reviewed 501 HTx patients prospectively enrolled in KOTRY. Among them, 13 patients who underwent combined heart and kidney transplantation (HKTx). Remaining patients were grouped as follows; Gr 1: Patients who were free of periop RRT. Gr 2: patients who required preop RRT but not postop RRT. Gr 3: patients who were free of preop RRT but necessitated postop RRT, Gr 4: patients who needed both preop and postop RRT. Postoperative RRT was defined as the need for dialysis after HTx during postoperative management. The primary outcome was dialysis dependent end-stage renal disease (ESRD). The secondary outcome was overall mortality. RESULTS Follow up duration was 22 months (9-39 month). Gr 4 pateints had significantly more ischemic heart disease, but less idiopathic DCMP. Patients who needed preop RRT (Gr 2 and 4) had higher incidence of DM. Significantly more patients who needed preop RRT (Gr 2 and Gr 4) experienced preHTx mechanical cardiac support and ventilator (p <0.001). Significantly more patients in G4 remained to be dialysis dependent ESRD (p<0.001) (Fig 1). Gr 4 patients had significantly higher mortality compared to rest of patients (Fig 2). Patients who underwent HKTx showed comparable survival rates (4 YR survival rates: 92.3%) with Gr 1. Gr 2 patients also showed comparable survival rates with Gr 1 (4 YR survival rates: 94.1%). CONCLUSION We suggested that HF patients on HTx waiting list with severe kidney dysfunction requiring RRT still should be considered for HTx. Among patients who needed preopRRT, those who did not require postop RRT showed comparable survival rates to pateints who were free of periop RRT. Also, those with ischemic HF and DM with severe renal dysfunction requiring preoperative RRT should be considered for HKTx to improve post HTx outcome.